Systematic review: noncoeliac gluten sensitivity

Area of Science:

• Gastroenterology
• Immunology
• Dietary Science

Background:

• Noncoeliac gluten sensitivity (NCGS) is an emerging disorder characterized by gluten intolerance symptoms.
• NCGS diagnosis relies on excluding celiac disease due to a lack of specific biomarkers.

Purpose of the Study:

• To determine the prevalence of NCGS.
• To evaluate the diagnostic exclusion of celiac disease in NCGS patients.
• To assess the efficacy of a gluten-free diet (GFD) for NCGS patients.

Main Methods:

• A comprehensive PubMed search was conducted up to December 2014.
• NCGS was defined using consensus criteria: self-reported gluten intolerance, negative celiac serology, and absence of villous atrophy.
• Included studies evaluated GFD impact on NCGS and irritable bowel syndrome (IBS) patients.

Main Results:

• NCGS prevalence ranged from 0.5% to 13%, with significant variability.
• A subset of NCGS patients (20%) were reclassified as celiac disease after advanced diagnostics (lymphocytic enteritis and HLA-DQ2/DQ8 haplotypes).
• A GFD showed variable results for NCGS but significantly improved stool frequency in HLA-DQ2 positive, diarrhea-predominant IBS patients.

Conclusions:

• NCGS prevalence is highly variable, and some cases may represent a milder form of celiac disease.
• The therapeutic benefit of a GFD for NCGS patients remains controversial.
• GFD may offer symptomatic improvement for specific IBS patient subgroups (HLA-DQ2 positive, diarrhea-predominant).