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The Overlapping Area of Non-Celiac Gluten Sensitivity (NCGS) and Wheat-Sensitive Irritable Bowel Syndrome (IBS)

06 Dec
Gluten-related disorders have recently been reclassified with an emerging scientific literature supporting the concept of non-celiac gluten sensitivity (NCGS).
Carlo Catassi 1, Armin Alaedini 2, Christian Bojarski 3, Bruno Bonaz 4, Gerd Bouma 5, Antonio Carroccio 6, Gemma Castillejo 7, Laura De Magistris 8, Walburga Dieterich 9, Diana Di Liberto 10, Luca Elli 11, Alessio Fasano 12, Marios Hadjivassiliou 13, Matthew Kurien 14, Elena Lionetti 1, Chris J. Mulder 5, Kamran Rostami 15, Anna Sapone 12, Katharina Scherf 16, Detlef Schuppan 17, Nick Trott 14, Umberto Volta 18, Victor Zevallos 17, Yurdagül Zopf 9 and David S. Sanders 14,*
1 Department of Pediatrics, Marche Polytechnic University, 60121 Ancona, Italy
2 Department of Medicine, Columbia University Medical Center, New York, NY 10027, USA
3 Medical Department, Division of Gastroenterology, Infectiology and Rheumatology, Charité, Campus Benjamin Franklin, 12203 Berlin, Germany
4 Department of Gastroenterology and Liver Diseases, CHU, 38043 Grenoble, France
5 Celiac Center Amsterdam, Department of Gastroenterology, VU University Medical Center, 1117 Amsterdam, The Netherlands
6 Department of Internal Medicine, “Giovanni Paolo II” Hospital, Sciacca (AG) and University of Palermo, 92019 Sciacca, Italy
7 Paediatric Gastroenterology Unit, Sant Joan de Reus University Hospital. IISPV, 43003 Tarragona, Spain
8 Department of Internal and Experimental Medicine Magrassi-Lanzara, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
9Medical Clinic 1, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
10Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), University of Palermo, 90133 Palermo, Italy
11Center for the Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
12Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA 02114, USA
13 Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
14 Academic Unit of Gastroenterology, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK
15 Gastroenterology Unit, Milton Keynes University Hospital, Milton Keynes MK6 5LD, UK
16 German Research Centre for Food Chemistry, Leibniz Institute, Lise-Meitner-Straße 34, D-85354 Freising, Germany
17 Institute of Translational Immunology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany
18 Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
* Correspondence: Tel.: +44-114-226-1179; Fax: +44-114-271-2692


Gluten-related disorders have recently been reclassified with an emerging scientific literature supporting the concept of non-celiac gluten sensitivity (NCGS). New research has specifically addressed prevalence, immune mechanisms, the recognition of non-immunoglobulin E (non-IgE) wheat allergy and overlap of NCGS with irritable bowel syndrome (IBS)-type symptoms. This review article will provide clinicians with an update that directly impacts on the management of a subgroup of their IBS patients whose symptoms are triggered by wheat ingestion.
gluten sensitivity; celiac disease; wheat allergy; gluten-related disorders; gluten-free diet; amylase-trypsin inhibitors (ATIs)

1. Introduction

Non-celiac gluten sensitivity (NCGS), sometimes referred as gluten sensitivity, gluten intolerance, or non-celiac wheat sensitivity, was already described in 1978 but did not receive much recognition from clinicians until the 21st century [1]. It is characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food, in subjects that are not affected by either celiac disease (CD) or wheat allergy (WA). This is the original definition based on the Salerno Experts’ Criteria [2]. However, our understanding has evolved since that time and we recognized that the spectrum of symptoms, which occur maybe due not just to the ingestion of gluten proteins but potentially other wheat-related components. In clinical practice, it is crucial to exclude CD in patients who present in this way. A recent PubMed search using the Medical Subject Headings (MeSH) index term of NCGS demonstrates 125 publications prior to 2000 but 490 since the start of the new millennium. Public and commercial interest in a gluten free diet (GFD) has galvanized the scientific community into undertaking research beyond the previously recognized gluten-related disorders such as celiac disease or dermatitis herpetiformis.
Irritable bowel syndrome (IBS) is a common intestinal disorder causing abdominal pain, bloating, gas, diarrhea and constipation. IBS-like complaints are often part of the NCGS clinical picture. Conversely, recent studies support the hypothesis that gluten and other wheat components may trigger IBS symptoms. Due to this overlap and lack of IBS/NCGS biomarkers, and there is a confusing situation for both the primary care physician and the general audience. This review article is aimed to present (1) an update on the complex relationship between NCGS and IBS and (2) the experts’ opinion on this hot topic.

 Published in Nutriens, Nov 21, 2017

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