Emerging concepts: from coeliac disease to non-coeliac gluten sensitivity

The rise in gluten consumption over time has led to the increasing recognition of coeliac disease (CD) with associated complications. However, only recently has there been an appreciation that the spectrum of gluten-related disorders is greater than just CD, which may explain the growing global popularity in gluten-free products. Current literature suggests that a newly recognised clinical entity in the form of non-coeliac gluten sensitivity (NCGS) may be the most common gluten-related disorder encountered by healthcare professionals, although its exact prevalence is as yet unknown. This article will review the historical relationship between mankind and gluten as well as the progressive recognition that it is possible for gluten to have a deleterious effect on our health. To this effect we discuss the prevalence, diagnosis and complications of CD including the benefits derived from a gluten-free diet (GFD). Finally, we discuss our current understanding of NCGS, in addition to highlighting the need for further research to determine the extent, clinicopathological features and serological biomarkers to help recognise this emerging condition in clinical practice.