Non-celiac gluten sensitivity: an emerging syndrome with many unsettled issues
Non-celiac gluten sensitivity is still an undefined syndrome with several unsettled issues despite the increasing awareness of its existence. Gluten is likely responsible for the clinical picture in a subset of patients, whereas in other cases it concurs to this syndrome together with fermentable mo...
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doaj-9c3bcae9bce14b268b7d276069cbce372020-11-25T01:24:46ZengPAGEPress PublicationsItalian Journal of Medicine1877-93441877-93522013-12-018422523110.4081/itjm.2013.461379Non-celiac gluten sensitivity: an emerging syndrome with many unsettled issuesUmberto Volta0Giacomo Caio1Francesco Tovoli2Roberto De Giorgio3Department of Medical and Surgical Sciences, Sant’Orsola-Malpighi Hospital, University of Bologna, BolognaDepartment of Medical and Surgical Sciences, Sant’Orsola-Malpighi Hospital, University of Bologna, BolognaDepartment of Medical and Surgical Sciences, Sant’Orsola-Malpighi Hospital, University of Bologna, BolognaDepartment of Medical and Surgical Sciences, Sant’Orsola-Malpighi Hospital, University of Bologna, BolognaNon-celiac gluten sensitivity is still an undefined syndrome with several unsettled issues despite the increasing awareness of its existence. Gluten is likely responsible for the clinical picture in a subset of patients, whereas in other cases it concurs to this syndrome together with fermentable mono-oligo-disaccharides and polyols and wheat proteins (<em>e.g</em>., amylase trypsin inhibitors). Innate immunity plays a pivotal role in the development of this syndrome, which is characterized by gut inflammation without villous atrophy and likely changes of intestinal barrier function. Data on its epidemiology are still undefined and largely variable. In the USA its prevalence varies from 0.6% to 6% in primary or tertiary care, respectively. Clinically, patients complain of gastrointestinal and extra-intestinal symptoms triggered by the ingestion of gluten without evidence of celiac disease and wheat allergy. Intestinal symptoms resemble those of irritable bowel syndrome, whereas neurological signs are quite common among extra-intestinal manifestations. So far, there are no biomarkers for non-celiac gluten sensitivity, but about half of patients shows anti-gliadin antibodies of immunoglobulin G class. Although not specific for non-celiac gluten sensitivity, the detection of such antibodies can support the diagnosis in patients with gluten-related symptoms. In the absence of diagnostic biomarkers a double-blind, placebo-controlled food challenge is currently the best way for confirming non-celiac gluten sensitivity. Studies aimed at clarifying the pathophysiological, clinical and laboratory features of non-celiac gluten sensitivity will help a better management of patients with this novel and intriguing clinical entity.http://www.italjmed.org/index.php/ijm/article/view/461non-celiac gluten sensitivity, innate immunity, epithelial barrier function, amylase trypsin inhibitors, fermentable oligo-, di-, and monosaccharides, and polyols, anti gliadin antibodies. |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Umberto Volta Giacomo Caio Francesco Tovoli Roberto De Giorgio |
spellingShingle |
Umberto Volta Giacomo Caio Francesco Tovoli Roberto De Giorgio Non-celiac gluten sensitivity: an emerging syndrome with many unsettled issues Italian Journal of Medicine non-celiac gluten sensitivity, innate immunity, epithelial barrier function, amylase trypsin inhibitors, fermentable oligo-, di-, and monosaccharides, and polyols, anti gliadin antibodies. |
author_facet |
Umberto Volta Giacomo Caio Francesco Tovoli Roberto De Giorgio |
author_sort |
Umberto Volta |
title |
Non-celiac gluten sensitivity: an emerging syndrome with many unsettled issues |
title_short |
Non-celiac gluten sensitivity: an emerging syndrome with many unsettled issues |
title_full |
Non-celiac gluten sensitivity: an emerging syndrome with many unsettled issues |
title_fullStr |
Non-celiac gluten sensitivity: an emerging syndrome with many unsettled issues |
title_full_unstemmed |
Non-celiac gluten sensitivity: an emerging syndrome with many unsettled issues |
title_sort |
non-celiac gluten sensitivity: an emerging syndrome with many unsettled issues |
publisher |
PAGEPress Publications |
series |
Italian Journal of Medicine |
issn |
1877-9344 1877-9352 |
publishDate |
2013-12-01 |
description |
Non-celiac gluten sensitivity is still an undefined syndrome with several unsettled issues despite the increasing awareness of its existence. Gluten is likely responsible for the clinical picture in a subset of patients, whereas in other cases it concurs to this syndrome together with fermentable mono-oligo-disaccharides and polyols and wheat proteins (<em>e.g</em>., amylase trypsin inhibitors). Innate immunity plays a pivotal role in the development of this syndrome, which is characterized by gut inflammation without villous atrophy and likely changes of intestinal barrier function. Data on its epidemiology are still undefined and largely variable. In the USA its prevalence varies from 0.6% to 6% in primary or tertiary care, respectively. Clinically, patients complain of gastrointestinal and extra-intestinal symptoms triggered by the ingestion of gluten without evidence of celiac disease and wheat allergy. Intestinal symptoms resemble those of irritable bowel syndrome, whereas neurological signs are quite common among extra-intestinal manifestations. So far, there are no biomarkers for non-celiac gluten sensitivity, but about half of patients shows anti-gliadin antibodies of immunoglobulin G class. Although not specific for non-celiac gluten sensitivity, the detection of such antibodies can support the diagnosis in patients with gluten-related symptoms. In the absence of diagnostic biomarkers a double-blind, placebo-controlled food challenge is currently the best way for confirming non-celiac gluten sensitivity. Studies aimed at clarifying the pathophysiological, clinical and laboratory features of non-celiac gluten sensitivity will help a better management of patients with this novel and intriguing clinical entity. |
topic |
non-celiac gluten sensitivity, innate immunity, epithelial barrier function, amylase trypsin inhibitors, fermentable oligo-, di-, and monosaccharides, and polyols, anti gliadin antibodies. |
url |
http://www.italjmed.org/index.php/ijm/article/view/461 |
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