Non celiac gluten sensitivity and diagnostic challenges

Non-celiac gluten sensitivity [NCGS], also referred to as non-celiac wheat sensitivity [NCWS], is a clinical syndrome characterized by both intestinal and extra-intestinal symptoms responsive to the withdrawal of gluten-containing food from the diet. The aim of this review is to summarize recent advances in research and provide a brief overview of the history of the condition for the benefit of professionals working in gastroenterology. Academic databases such as PubMed and Google Scholar were searched using key words such as 'non-celiac gluten sensitivity', 'gluten related disorders', and the studies outlined in reference page were selected and analysed.Most of the analysed studiers agree that NCGS would need to be diagnosed only after exclusion of celiac disease and wheat allergy, and that a reliable serological marker is not available presently. The mechanisms causing symptoms in NCGS after gluten ingestion are largely unknown, but recent advances have begun to offer novel insights. The estimated prevalence of NCGS, at present, varies between 0.6 and 6%. There is an overlap between irritable bowel syndrome and NCGS with regard to the similarity of gastrointestinal symptoms. The histologic characteristics of NCGS are still under investigation, ranging from normal histology to slight increase in the number of T lymphocytes in the superficial epithelium of villi. Positive response to gluten free diet for a limited period [e.g., 6 weeks], followed by the reappearance of symptoms after gluten challenge appears, at this moment, to be the best approach for confirming diagnosis. The Salerno expert criteria may help to diagnose NCGS accurately in particular for research purposes but it has limited applicability in clinical practice

exploration into the motivation for gluten avoidance in the absence of coeliac disease

Aim: To explore the motivation for gluten avoidance in the absence of coeliac disease [CD] and ascertain what symptoms are triggered by gluten and what beliefs/reasons influence this decision

Background: Links between physical/psychological symptoms and gluten in CD are well known but less is known about those who self-select a gluten-free diet [GFD] in the absence of CD

Methods: An empirical study using responses to an anonymous on-line questionnaire. Closed questions were used as a screening tool to exclude participants who had CD, wheat allergy or were following a low FODMAP diet. Data from participants using a GFD in the absence of a medical diagnosis was then analysed using thematic analysis

Results: 120 initial responses, 87 were completed in full. 23 respondents fulfilled the inclusion criteria for thematic analysis. 7 different themes emerged, including one for signs/symptoms. Other themes identified included difficulties of a GFD, health beliefs, feelings and influence on decision to follow a GFD. Responses indicate that the reasons for gluten avoidance are in the most part reasoned and logical and were based around participants' self-management of symptoms

Conclusion: Symptoms included those typical of irritable bowel syndrome [IBS], but also infertility, low mood/energy, immune function and weight management and visual and auditory hallucinations. It appears the majority of responses analysed thematically could fit into the spectrum of non-coeliac gluten sensitivity [NCGS]. Findings also suggest more support at all levels of medical care may help patients establish if it is gluten, rather than wheat or FODMAPs particularly fructans that are contributing to signs/symptoms

Non-coeliac gluten sensitivity and reproductive disorders

An association between coeliac disease and fertility disorders is well recognised in the current literature, but the information related to non-coeliac gluten sensitivity [NCGS] and infertility is lacking. This case highlights a possible role of treating NCGS in the reversal of infertility

Microscopic Enteritis; clinical features and correlations with symptoms

To assess the clinical characteristic of CD as well as correlation of symptoms and the degrees of intestinal mucosal lesions in Iranian children. Microscopic Enteritis [Marsh 0-II] is associated with malabsorption. From August 2005 to September 2009, 111 cases with malabsorption and classical gastrointestinal symptoms were evaluated. The mean [ +/- SD] age of children with CD was 4.9 +/- 3.5 years [range, 6 month-16 years] and the mean duration of symptoms was 8 +/- 20.5 months. 50 cases [45%] were female and 61 cases [55%] were male. The most common clinical presentation was failure to thrive in 72%, chronic diarrhea in 65.8% and Iron deficiency anemia in 59.5%. Sensitivity of EMA was 100% in patients with Marsh IIIb and Marsh IIIc. EMA was also positive in 77% of cases with Marsh 0, 18% in Marsh I, 44% in Marsh II and 81.8% in patients with Marsh IIIa. Histopathology did not reflect the severity of gluten sensitivity. This would suggest that the degree of intestinal mucosal damage might not be a reliable prognostic factor. Significant symptoms can be present with minor histological change on biopsy

Gluten tolerance; potential challenges in treatment strategies

Tolerable gluten thresholds in gluten free products have long been debated together with issues of cross contamination of gluten free cereals during the milling process. It is well established that a totally gluten free diet is virtually impossible owing to the presence of traces of gluten. It is estimated that daily consumption of gluten from contaminated gluten free foods is in the range of 5 to 50 mg. We believe evidence is mounting that it may be possible for some celiac patients to tolerate gluten above the limits considered permissible at threshold levels. Conversely, it seems there is evidence that some patients might have a much lower threshold for gluten. Whatever would be the individual threshold, GFD may be of benefit to any symptomatic patients even those with milder enteropathy like microscopic enteritis

impact of breakfast in metabolic and digestive health

The purpose of this study is to explore whether the types and quality of breakfast could influence energy levels [blood glucose levels] and propose ideal breakfast models. It is widely considered that a regular breakfast provides a number of health benefits; however, there is no general scientific agreement regarding what kind of food should be consumed. Evidence supports the importance of balancing blood glucose levels by low glycaemic index/load [L-GI/L] and increased protein diets, in particular in metabolic disorders, which non-alcoholic fatty liver disease [NAFLD] has a close relation to. This study was conducted by using a valid and standard questionnaire at the University of Worcester to evaluate the breakfast and dietary habits and energy levels. The Kruskal-Wallis test was used for statistical analysis. No significant differences were found either between breakfast consumption, energy levels, types of snack and amount of caffeine intake in the morning or between types of breakfast, energy levels, types of snack, and amount of caffeine intake in the morning. However, potential differences in energy levels were found across the groups of breakfast types: glycaemia [GL] [p=.057] and protein intake [p=.056]. The types and quality of breakfast would be key as regular breakfast were found to be associated with higher energy levels. It is therefore recommended that breakfast foods should be low in GL and high in protein. These changes may lead to better health status and prevention of disease, especially metabolic and liver disorders, in the long term