Abstract
There has been increasing recognition in the medical community and the general public of the widespread prevalence of gluten sensitivity. Celiac disease (CD) was initially believed to be the sole source of this phenomenon. Signs and symptoms indicative of nonceliac gluten sensitivity (NCGS), in which classical serum and intestinal findings of CD may be absent, have been frequently reported of late. Clinical manifestations in patients with NCGS are characteristically triggered by gluten and are ameliorated or resolved within days to weeks of commencing a gluten-free diet. Emerging scientific literature contains several reports linking gluten sensitivity states with neuropsychiatric manifestations including autism, schizophrenia, and ataxia. A clinical review of gluten sensitivity is presented alongside a case illustrating the life-changing difference achieved by gluten elimination in a patient with a longstanding history of auditory and visual hallucinations. Physicians in clinical practice should routinely consider sensitivity issues as an etiological determinant of otherwise inexplicable symptoms. Pathophysiologic mechanisms to explain the multisystem symptomatology with gluten sensitivity are considered.
Highlights
Over the last decade, there have been increasing reports of myriad adverse reactions associated with gluten exposure
Emerging scientific literature has noted a link between gluten ingestion and symptomatology from nearly every organ system, often in the absence of classic histological findings of celiac disease (CD) on intestinal biopsy
A group led by Gibson et al in Australia first published a double-blind, randomized study confirming the reality of nonceliac gluten sensitivity (NCGS) as a bonafide medical condition [22], diagnostic criteria continue to be debated as the diagnosis is essentially determined as a result of self-reporting by patients
Summary
There have been increasing reports of myriad adverse reactions associated with gluten exposure. Emerging scientific literature has noted a link between gluten ingestion and symptomatology from nearly every organ system, often in the absence of classic histological findings of CD on intestinal biopsy. It has been hypothesized for quite some time that gluten sensitivity may impair central nervous system functioning [1]. Similar results continue to be reported in the medical literature and give credence to the association between gluten sensitivity and neurological symptoms in the absence of celiac disease [3,4,5,6]. A case history of a 23year-old female with a longstanding history of auditory and visual hallucinations is initially presented as an example of what can be clinically achieved in gluten sensitive individuals following elimination of the inciting food trigger
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