Abstract
Non-celiac gluten or wheat sensitivity (NCWS) is a “clinical entity induced by the ingestion of wheat leading to intestinal and/or extraintestinal symptoms that improve once the wheat-containing foodstuff is removed from the diet, and celiac disease and wheat allergy have been excluded”. This mostly accepted definition raises several points that remain controversial on this condition. In the present review, the authors summarize the most recent advances in the clinic and research on NCWS through an accurate analysis of different studies. We screened PubMed, Medline, Embase, and Scopus using the keywords “non-celiac gluten sensitivity”, “non-celiac wheat sensitivity”, and “diagnosis”. We would like to emphasize two main points, including (A) the controversial clinical and etiological aspects in different trials and experiences with particular attention to the Salerno criteria for the diagnosis of NCWS and (B) the histological aspects. The etiology of NCWS remains controversial, and the relationship with irritable bowel syndrome is obscure. Histologically, the duodenal mucosa may show a variable pattern from unremarkable to a slight increase in the number of T lymphocytes in the superficial epithelium of villi. The endorsement of this disease is based on a positive response to a gluten-free diet for a limited period, followed by the reappearance of symptoms after gluten challenge. The Salerno expert criteria may help to diagnose NCWS accurately. Social media and inaccurate interpretation of websites may jeopardize the diagnostic process if individuals self-label as gluten intolerant.
Highlights
For more than 40 years, the polymorphic spectrum of presentation in clinical symptoms, laboratory data and histological characteristics of celiac disease has been compared to a “chameleon” [1, 2], and gastroenterologists seek refuge in further diagnostic tests or more complicated levels of genetic diagnosis
A total of 26 studies were found to be relevant for diagnosis and histology, but this number was expanded to include several aspects that are crucial for the narrative section of the review [3–71]
Non-celiac gluten or wheat sensitivity (NCWS) is often considered a very recently discovered clinical condition, it was known more than 40 years ago, when Ellis and Linaker presented the case of a 43-year-old patient with diarrhea in the absence of celiac disease, who showed a marked improvement with the removal of gluten from the diet [72]
Summary
For more than 40 years, the polymorphic spectrum of presentation in clinical symptoms, laboratory data and histological characteristics of celiac disease has been compared to a “chameleon” [1, 2], and gastroenterologists seek refuge in further diagnostic tests or more complicated levels of genetic diagnosis. If all these test results are negative, it is suggested to indicate that the patient. We searched the key words alongside the following limitations: English language, human studies, and clinical trials. Reference lists and reviews were further hand-searched to identify RCTs
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
