Abstract
Celiac disease (CD) and non-celiac gluten/wheat sensitivity (NCG/WS) are the two most frequent conditions belonging to gluten-related disorders (GRDs). Both these diseases are triggered and worsened by gluten proteins ingestion, although other components, such as amylase/trypsin inhibitors (ATI) and fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs), seem to be involved in the NCG/WS onset. Therefore, the only effective treatment to date is the long-life adherence to a strictly gluten-free diet. Recently, increasing attention has been paid to the intestinal barrier, a dynamic system comprising various components, which regulate the delicate crosstalk between metabolic, motor, neuroendocrine and immunological functions. Among the elements characterizing the intestinal barrier, the microbiota plays a key role, modulating the gut integrity maintenance, the immune response and the inflammation process, linked to the CD and NCG/WS outbreak. This narrative review addresses the most recent findings on the gut microbiota modulation induced by the gluten-free diet (GFD) in healthy, CD and NCG/WS patients.
Highlights
Celiac disease (CD) and non-celiac gluten/wheat sensitivity (NCG/WS) are the two most common conditions among gluten-related disorders (GRDs), a broad spectrum of diseases evoked by gluten ingestion, which includes wheat allergy (WA), dermatitis herpetiformis, gluten ataxia and other clinical phenotypes [1,2,3,4,5]
Since the gut microbiota exert a major influential role on barrier function and immune maturation and response, the sections have addressed the consequences related to dysbiosis, i.e., the changes occurring in the myriad of various germs populating the whole gut in CD and NCG/WS even when such patients are properly treated with gluten-free diet (GFD) [60]
CD: celiac disease; GFD: gluten-free diet; NCG/WS: non-celiac gluten/wheat sensitivity; TCD: GFD treated CD; UCD: GFD untreated CD. * in a low gluten containing diet. ↑ means the increasing of bacterial populations following GFD, ↑ means the decreasing of bacterial populations following GFD
Summary
Celiac disease (CD) and non-celiac gluten/wheat sensitivity (NCG/WS) are the two most common conditions among gluten-related disorders (GRDs), a broad spectrum of diseases evoked by gluten ingestion, which includes wheat allergy (WA), dermatitis herpetiformis, gluten ataxia and other clinical phenotypes [1,2,3,4,5]. The intestinal barrier is the largest surface in contact with the environment and is constituted by an anatomical barrier (i.e., enterocytes and TJs), and by several other factors such as mucus, digestive enzymes, immune system, the gut–vascular barrier, enteric nervous system and the gut microbiota Taking these key components together, the intestinal barrier can be viewed as an “anatomical-microbiological” unit acting in concert with secretory, absorptive, motor, neuroendocrine and immunological functions [12,13]. A fast-growing number of pathological conditions, including autoimmune diseases, food intolerances, allergies and sensitivities have been related to alterations of the intestinal barrier [14] This narrative review will focus on the gut microbiota changes in response to a gluten-free diet (GFD) in CD and NCG/WS patients. Defining these aspects will help to shed light on the interplay between gut microbiota and intestinal barrier function, a major emerging pathogenetic paradigm involved in several conditions including GRDs
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