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Non-coeliac gluten sensitivity.

Peter R Gibson1, Gry I Skodje2, Knut E A Lundin3

  • 1Department of Gastroenterology, Monash University and Alfred Hospital, Melbourne, Australia.

Journal of Gastroenterology and Hepatology
|March 1, 2017
PubMed
Summary
This summary is machine-generated.

Wheat ingestion causes irritable bowel syndrome-like symptoms, but the exact cause (gluten, other proteins, or FODMAPs) remains unclear. Further research is needed to resolve diagnostic challenges and understand gluten sensitivity.

Keywords:
FODMAPsamylase-trypsin inhibitorsdietary rechallengefructansintraepithelial lymphocytesnocebo responses

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Area of Science:

  • Gastroenterology
  • Immunology
  • Dietary Science

Background:

  • Wheat ingestion frequently triggers irritable bowel syndrome-like symptoms.
  • The specific triggers, including gluten, other wheat proteins, or FODMAPs, are not clearly defined.
  • Diagnosing non-coeliac gluten sensitivity is complicated by challenges in excluding coeliac disease and managing nocebo responses.

Purpose of the Study:

  • To clarify the etiological factors behind wheat-induced gastrointestinal symptoms.
  • To address the diagnostic complexities and controversies surrounding non-coeliac gluten sensitivity.
  • To highlight the need for further research to establish clear diagnostic and therapeutic guidelines.

Main Methods:

  • Review of existing literature on wheat sensitivity and irritable bowel syndrome.
  • Analysis of diagnostic criteria for coeliac disease and non-coeliac gluten sensitivity.
  • Discussion of challenges in blinded, placebo-controlled rechallenge studies.

Main Results:

  • The precise cause of wheat sensitivity remains ambiguous, with contributions from gluten, other wheat proteins, and FODMAPs possible.
  • Diagnostic certainty is hampered by difficulties in coeliac disease exclusion and significant nocebo effects in patients.
  • Lack of a defined biological mechanism and research design issues contribute to ongoing controversy.

Conclusions:

  • The diagnosis, epidemiology, and treatment of potential gluten sensitivity require further investigation.
  • Resolving the controversy necessitates a deeper understanding of the underlying mechanisms and improved research methodologies.
  • Clarification of wheat-induced symptoms is crucial for effective patient management.