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Non-coeliac gluten or wheat sensitivity: emerging disease or misdiagnosis?

Michael DE Potter, Marjorie M Walker and Nicholas J Talley
Med J Aust 2017; 207 (5): 211-215. || doi: 10.5694/mja17.00332

Summary

 

  • Non-coeliac gluten or wheat sensitivity (NCG/WS) is a condition characterised by adverse gastrointestinal and/or extra-intestinal symptoms associated with the ingestion of gluten- or wheat-containing foods, in the absence of coeliac disease or wheat allergy.
  • Up to one in 100 people in Australia may have coeliac disease but many more report adverse gastrointestinal and/or extra-intestinal symptoms after eating wheat products.
  • In the absence of validated biomarkers, a diagnosis of NCG/WS can only be made by a double-blind, placebo-controlled, dietary crossover challenge with gluten, which is difficult to apply in clinical practice.
  • Of people self-reporting gluten or wheat sensitivity, only a small proportion (16%) will have reproducible symptoms after a blinded gluten challenge of gluten versus placebo in a crossover dietary trial and fulfil the current consensus criteria for a diagnosis of NCG/WS.
  • A wide range of symptoms are associated with NCG/WS, including gastrointestinal, neurological, psychiatric, rheumatological and dermatological complaints.
  • The pathogenesis of NCG/WS is not well understood, but the innate immune system has been implicated, and there is overlap with coeliac disease and the functional gastrointestinal disorders (irritable bowel syndrome and functional dyspepsia).
  • Identification of NCG/WS is important as gluten-free diets carry risks, are socially restricting and are costlier than regular diets.

 

  • Michael DE Potter1
  • Marjorie M Walker1
  • Nicholas J Talley1,2

  • 1 University of Newcastle, Newcastle, NSW
  • 2 Medical Journal of Australia, Sydney, NSW


Competing interests:

Nicholas Talley is Editor-in-Chief of the Medical Journal of Australia.

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