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From coeliac disease to noncoeliac gluten sensitivity; should everyone be gluten free?

Aziz, Imran; Dwivedi, Krit; Sanders, David S.

Current Opinion in Gastroenterology: March 2016 - Volume 32 - Issue 2 - p 120–127
doi: 10.1097/MOG.0000000000000248
NUTRITION: Edited by Eamonn M.M. Quigley
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Purpose of review Gluten-free diets (GFDs) have seen a disproportional rise in use and popularity relative to the prevalence of established gluten-related disorders such as coeliac disease or immunoglobulin E wheat allergy. This entity has been termed noncoeliac gluten sensitivity (NCGS). This review aims to provide a current perspective on the emerging evidence for and against NCGS, along with the associated need for a GFD.

Recent findings NCGS and the benefits of a GFD are reported amongst patients with irritable bowel syndrome, inflammatory bowel disease, and nonintestinal disorders such as neuropsychiatric diseases and fibromyalgia. However, no reliable biomarkers currently exist to diagnose NCGS and hence confirmatory testing can only be performed using double-blind placebo-controlled gluten-based challenges. Unfortunately, such tests are not available in routine clinical practice. Furthermore, recent novel studies have highlighted the role of other gluten-based components in contributing to the symptoms of self-reported NCGS. These include fermentable oligo, di, mono-saccharides and polyols, amylase trypsin inhibitors, and wheat germ agglutinins. Therefore, NCGS is now seen as a spectrum encompassing several biological responses and terms such as ‘noncoeliac wheat sensitivity’ have been suggested as a wider label to define the condition.

Summary Despite the rising use of a GFD further studies are required to clearly establish the extent and exclusivity of gluten in NCGS.

Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK

Correspondence to Imran Aziz, Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, S10 2JF, UK. Fax: +44 114 2712692; e-mail: imran.aziz@sth.nhs.uk

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