The sensitivity to gluten non-celiac is a recently introduced disorder in the medical vocabulary, used to identify all cases in which a patient experiences symptoms characteristic of celiac disease , and benefits from a gluten-free diet , despite the medical examination can be excluded the presence of celiac disease or allergies to wheat .
Therefore, a subject sensitive to gluten manifests the typical symptoms of celiac disease even if it is not affected.
Non-celiac gluten sensitivity is also known as NCGS ( Non-celiac gluten sensitivity ).
Differences with celiac disease
Celiac disease is a chronic autoimmune disease of the small intestine that affects genetically predisposed individuals of all age groups .
In celiac patients, the ingestion of gluten-containing foods (containing gluten) triggers an immune response in the intestine, which damages the mucous membrane of the small intestine .
This damage results in the typical symptoms of celiac disease , which include abdominal pain , chronic diarrhea and / or constipation , growth retardation (in children), anemia and psychophysical fatigue.
Today we have several non-invasive tests available for the diagnosis of celiac disease , which allow us to evaluate the presence or absence of the typical autoimmune response to gluten; these tests are gradually replacing the test traditionally considered more reliable, that is the intestinal biopsy (through a “tube” introduced into the mouth and guided by a camera to the small intestine, the doctor takes samples of the intestinal mucosa ). To be able to talk about celiac disease, therefore, the presence of strongly suggestive symptoms is NOT enough, but it is necessary, always and in any case, to demonstrate their existence through specific tests. This is a very important aspect, also because sometimes the symptoms of celiac disease they are absent or manifest in an atypical way.
We can therefore have celiac subjects who do not manifest intestinal disorders . In non-celiac gluten sensitivity, on the other hand, exactly the opposite happens, ie we have symptoms suggestive of celiac disease despite – following the tests just seen – it is possible to exclude the presence of the disease (no trace of ” anti-gluten antibodies ” and no trace of lesions of the intestinal mucosa).
Typically, gluten sensitivity is a less severe disorder than celiac disease.
Differences with wheat allergy
Wheat allergy is an allergic reaction to wheat proteins . The differences with respect to celiac disease lie in the type of antibodies involved (as well as in the severity of associated symptoms): while in celiac disease specific autoantibodies against tissue transglutaminase 2 (anti-TG2) are involved, in wheat allergy specific IgE antibodies are involved for some of its proteins .
As mentioned, there are also differences at the symptomatological level, since wheat allergy is mainly characterized by disorders of the respiratory system ( baker’s asthma ), sometimes with rather violent manifestations ( anaphylaxis induced by physical exercise ).
The diagnosis of wheat allergy mainly uses prick tests and specific RASTs .
Non-celiac gluten sensitivity is characterized by intestinal and extra-intestinal symptoms related to the ingestion of foods containing gluten. Such symptoms may include:
- Abdominal painand swelling ;
- Alterations of the hive(diarrhea or constipation );
- Dermatitis( eczema and skin rashes with redness and itching );
- Headacheand clouded mind;
- Fatigue, with or without muscle-joint pain.
All these symptoms typically disappear with the elimination of gluten from the diet, only to reappear after its reintroduction, usually within hours or a few days.
Gluten sensitivity and irritable bowel syndrome
IBS – better known as irritable bowel (or colon) syndrome – is a gastrointestinal disorder of functional (NOT pathological) origin. In order to diagnose its presence, it is therefore necessary to first of all exclude any disease potentially responsible for the typical symptoms of IBS , which include chronic diarrhea and / or constipation, abdominal pain and cramps , bloating and flatulence .
Therefore, although the symptoms are similar, a person with IBS cannot be considered celiac , precisely because this condition must be excluded a priori even before we can speak of IBS.
The theories on the causes of irritable bowel syndrome are diverse and there is some consensus in considering it a multifactorial disorder; it means that various causes, of a genetic and environmental nature, would contribute to its onset. Among these there would also be hypersensitivity to certain substances introduced with food, commonly responsible for food intolerances (gluten, lactose, salicylates, etc.).
The confirmation of this hypothesis derives from the fact that many people with IBS derive significant benefits from an exclusion diet, that is, devoid of the substances mentioned above.
Based on these considerations, also confirmed by experimental evidence, it is plausible that a certain percentage of people with IBS (around 25-35%) are affected by non-celiac gluten sensitivity. This condition can be present in isolation or in a context of multiple intolerances .
As this is a newly defined disorder, there are still several question marks about the causes of non-celiac gluten sensitivity.
According to some authors, non-celiac gluten sensitivity would be the “simple” expression of gastrointestinal disturbances ( digestive difficulties of different nature and / or dysbiosis ) and / or eating disorders. If something does not work perfectly in the digestion of foods and / or in the absorption of the nutrients contained in them, the non-absorbed substances are fermented by the intestinal microbial flora , with the production of gas , fatty acids and other substances that can trigger the typical symptoms of IBS and NCGS. In case of too abundant and varied meals, intestinal disorders, chronic caloric surplus compared to the body’s needs, the share of nutrientsnot absorbed increases significantly, generating the symptoms listed above. At the same time, due to a loss of selectivity of the intestinal mucosa, there could also be an absorption of potentially sensitizing substances, which in normal conditions would be excreted with the faeces. All this to say that a subject considered sensitive to gluten could simply be a person who has been eating “too much and badly” for too long.
Molecular characterization studies, more and more numerous, are trying to identify markers of the disorder, which however are not always detectable. Preliminary evidence in this area seems to paint gluten sensitivity as a particular congenital immune reaction to gluten, naturally different from that which gives rise to celiac disease.
In the course of the article we have seen how in subjects with gluten sensitivity it is not possible to demonstrate the presence of either specific antibodies for celiac disease (or for wheat allergy) or of the classic lesions of the intestinal mucosa with atrophy of the villi (possibly present in extremely mild form).
There are currently no internationally recognized scientific tests specific to the diagnosis of NCGS.
As with IBS, therefore, the diagnosis of non-celiac gluten sensitivity is a diagnosis of exclusion, which is reached after tests for wheat allergy and celiac disease have given negative results. Recall also that in order to talk about NCGS necessary that the associated symptoms disappear after the adoption of a gluten-free diet and recur after re-introduction of gluten in the diet. It would also be preferable for such reintroduction to occur without the patient’s knowledge, so as to rule out a possible placebo effect .
Non-Celiac Gluten Sensitivity treatment is based on adopting a gluten-free diet for a certain period. It is therefore the same intervention reserved in the presence of celiac disease, with the difference that in NCGS the suspension of gluten diets could be only temporary.
Clearly, in addition to this aspect, it is necessary to re-evaluate, with the help of a professional, nutrition in its entirety, from food combinations to any intolerances or hypersensitivity , from the intake of fiber to that of simple sugars , from the consumption of rich foods of additives to the water intake. Equally important is the evaluation of certain psychological and behavioral elements, such as the level of physical activity, any stressors at family or work level and the possible intake of drugs, laxatives , alcohol and drugs.