The phenomenon of gluten sensitivity in the absence of celiac disease is not new; it was first described in medical literature in the late 1970s. Since then, clinicians have continued to encounter patients who report adverse reactions to gluten, despite testing negative for celiac disease. This has led to further research and increased publication on the subject.

Non-celiac gluten sensitivity continues to be widely debated. Still unclear is whether individuals are reacting to gluten or to some other component in foods. On the other hand, individuals with so-called non-celiac gluten sensitivity actually may have undiagnosed celiac disease.

Symptoms

It is characterized by a wide variety of both intestinal and extra-intestinal symptoms including abdominal pain, bloating, gas, diarrhea or constipation, unexplained anemia, headaches, “foggy mind,” depression, chronic fatigue, skin rash, leg numbness and joint pain.

Prevalence

The true prevalence is unknown at this time, although it is estimated that between 0.5%–13% of the general population may have this condition.

Diagnosis

Due to limited understanding of the pathophysiology, there are no diagnostic markers for non-celiac gluten sensitivity. Currently, the only way to determine if someone may have non-celiac gluten sensitivity is to first rule out celiac disease and wheat allergy, then observe the response to a gluten-free diet and a gluten challenge. It is essential that the celiac serology and an intestinal biopsy have been completed before initiating a gluten–free diet.

Treatment

It is recommended that individuals with non-celiac gluten sensitivity follow a gluten-free diet to alleviate symptoms; however, whether gluten must be strictly avoided for life (as is necessary with celiac disease) is at present unknown.