Celiac Disease and Non-Celiac Gluten Sensitivity

The prevalence of gluten-related disorders is rising, and increasing numbers of individuals are empirically (through observation or experience) trying a gluten-free diet for a variety of signs and symptoms. This review aims to present current evidence regarding screening, diagnosis, and treatment for celiac disease and nonceliac gluten sensitivity.
Celiac disease is a gluten-induced immune-mediated enteropathy (disease of the intestine) characterized by a specific genetic genotype (HLA-DQ2 and HLA-DQ8 genes) and autoantibodies (antitissue transglutaminase and antiendomysial). Although the inflammatory process specifically targets the intestinal mucosa, patients may present with gastrointestinal signs or symptoms, extraintestinal signs or symptoms, or both, suggesting that celiac disease is a systemic disease. Nonceliac gluten sensitivity is diagnosed in individuals who do not have celiac disease or wheat allergy but who have intestinal symptoms, extraintestinal symptoms, or both, related to ingestion of gluten-containing grains, with symptomatic improvement on their withdrawal. The clinical variability and the lack of validated biomarkers for nonceliac gluten sensitivity make establishing the prevalence, reaching a diagnosis, and further study of this condition difficult. Nevertheless, it is possible to differentiate specific gluten-related disorders from other conditions, based on currently available investigations and algorithms. Clinicians cannot distinguish between celiac disease and nonceliac gluten sensitivity by symptoms, as they are similar in both. Therefore, screening for celiac disease must occur before a gluten-free diet is implemented, since once a patient initiates a gluten-free diet, testing for celiac disease is no longer accurate.
* The authors of this clinical review present the current evidence regarding the diagnosis and management of celiac disease and non-celiac gluten sensitivity. Celiac disease is an immune-mediated enteropathy (a disease of the intestine) caused by exposure to gluten. Patients have a well-defined genotype and measurable autoantibodies. The frequent presence of extra-intestinal signs or symptoms confirms the systemic nature of celiac disease despite the intestinal mucosa being the main target of inflammation. In contrast, non-celiac gluten sensitivity occurs in patients with symptoms related to ingestion of gluten; it resolves with dietary exclusion of gluten.
* Both celiac disease and non-celiac gluten sensitivity are managed with a gluten-free diet. The diagnosis should be confirmed prior to exclusion of gluten to ensure appropriate long-term management.
Celiac disease and nonceliac gluten sensitivity are common. Although both conditions are treated with a gluten-free diet, distinguishing between celiac disease and nonceliac gluten sensitivity is important for long-term therapy. Patients with celiac disease should be followed up closely for dietary adherence, nutritional deficiencies, and the development of possible comorbidities (The presence of one or more additional diseases or disorders.
At Botanica Medica our Naturopaths are well aware of the importance of a good diet and the effect it can have on your life both physically and mentally. They come across lots of interesting studies and are always updating their knowledge. If you would like to make an appointment with one of our Naturopaths call Botanica Medica on 8271-1827 today. They are only to happy to share the knowledge they have gained through their studies and patient outcomes, and get you feeling better. Botanica Medica is located at 97 Glen Osmond Road, Eastwood and appointments are available Monday to Saturday including some after hours.
Published in Primary Care
Journal Scan / Review · August 28, 2017
Celiac Disease and Non-Celiac Gluten Sensitivity
JAMA: The Journal of the American Medical Association
Maureen M. Leonard, MD, MMSc1,2; Anna Sapone, MD, PhD1,2,3; Carlo Catassi, MD, MPH1,2,4,5; et al
Alessio Fasano, MD1,2,4
Author Affiliations
JAMA. 2017;318(7):647-656. doi:10.1001/jama.2017.9730