Wheat-Related Gastrointestinal Diseases: Narrative Review

Area of Science:

• Gastroenterology and Immunology
• Dietary Intolerances
• Wheat and Gluten-Related Disorders

Background:

• Growing public and scientific interest in wheat and gluten intolerance.
• Celiac disease (CD) and wheat allergy are well-defined conditions with known mechanisms and diagnostics.
• Non-celiac wheat sensitivity (NCWS) is a controversial category lacking a defined pathophysiology.

Purpose of the Study:

• To review the epidemiology, etiology, clinical manifestations, diagnosis, and management of wheat-related disorders.
• To differentiate between celiac disease, wheat allergy, and non-celiac wheat sensitivity.
• To explore the controversial nature and potential mechanisms of NCWS.

Main Methods:

• Literature review of epidemiological data.
• Analysis of etiological factors and proposed mechanisms.
• Summary of diagnostic criteria and clinical presentations.
• Overview of current management strategies.

Main Results:

• CD and wheat allergy have established diagnostic pathways.
• NCWS diagnosis is based on symptom exclusion and response to gluten withdrawal.
• Double-blind placebo-controlled trials suggest a significant nocebo component in NCWS.
• NCWS may overlap with or be a form of irritable bowel syndrome.

Conclusions:

• Understanding the distinct characteristics of CD, wheat allergy, and NCWS is crucial for accurate diagnosis.
• Further research is needed to elucidate the pathophysiology of NCWS.
• Management strategies should be tailored to the specific condition, considering the potential role of psychological factors in NCWS.