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Non-coeliac gluten sensitivity.

Jessica R Biesiekierski1, Daisy Jonkers2, Carolina Ciacci3

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Summary
This summary is machine-generated.

Non-coeliac gluten sensitivity (NCGS) is a condition where individuals experience symptoms after eating gluten, but without coeliac disease or wheat allergy. Research suggests fermentable carbohydrates and psychological factors significantly contribute to symptoms, complicating diagnosis.

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Area of Science:

  • Gastroenterology
  • Clinical Nutrition
  • Dietetics

Background:

  • Non-coeliac gluten sensitivity (NCGS) affects individuals reporting symptoms from gluten or wheat ingestion, distinct from coeliac disease or wheat allergy.
  • While ~10% of adults self-report gluten sensitivity, controlled studies show 16-30% have gluten-specific triggers, though methodology is variable.
  • Fermentable carbohydrates and nocebo effects are implicated in symptom generation, alongside commercial and media influences on research and perception.

Purpose of the Study:

  • To critically review current evidence on NCGS as a distinct entity.
  • To explore potential mechanisms underlying NCGS symptoms.
  • To provide practical guidance for assessment and management of NCGS.

Main Methods:

  • Systematic review of existing literature on NCGS.
  • Analysis of diagnostic challenges, including lack of biomarkers and overlap with gut-brain interaction disorders.
  • Evaluation of dietary assessment methodologies and their limitations.

Main Results:

  • Definitive diagnosis of NCGS is challenging due to absence of biomarkers and methodological variability.
  • Fermentable carbohydrates and nocebo effects play a considerable role in symptom development.
  • NCGS remains a diagnosis of exclusion requiring careful evaluation.

Conclusions:

  • NCGS diagnosis is elusive, necessitating a systematic approach balancing dietary changes with psychological factors and nutritional adequacy.
  • Further research is needed to identify causative agents and develop diagnostic tests.
  • Management requires acknowledging uncertainties and focusing on individualized care.