Nonceliac gluten sensitivity: an approach to diagnosis and management

Symptoms attributed to gluten consumption are frequently reported evoking the need for differentiating nonceliac gluten sensitivity (NCGS) from other gluten-related disorders such as celiac disease and wheat allergy. This review discusses diagnostic criteria and research to date on the pathogenesis and diagnosis of NCGS.

There is recent evidence to support NCGS as a distinct clinical entity. The symptoms attributed to NCGS are nonspecific, overlapping with those reported in patients with celiac disease and irritable bowel syndrome. In contrast to celiac disease and wheat allergy, the diagnosis of NCGS is more challenging because there are no specific clinical biomarkers and because the pathogenesis of NCGS is largely not well understood. The pathogenesis of NCGS may reflect alterations in innate immunity to gluten or other components of wheat, may be linked with autoimmunity, or is a result of a reaction to gluten as a fermentable carbohydrate.

NCGS is a newly characterized and evolving clinical entity that requires ruling out other causes of wheat-related or gluten-related gastrointestinal symptoms, including celiac disease and wheat allergy, coupled with double-blind placebo-controlled crossover challenge with gluten.