Diagnosis Of Non-celiac Gluten Sensitivity Research Articles

Non Celiac Gluten Sensitivity-exploring the New Entity

BackgroundSpectrum of gluten-related disorders got a new entity, represented by gluten sensitivity. Clinical picture is a combination of IBS (irritable bowel syndrome) symptoms and of systemic manifestations. No strict criteria for the diagnosis of NCGS exist, prevalence claimed to be up to 6%.ObjectivesTo study the prevalence of non-celiac gluten sensitivity (NCGS) and response to dietary intervention in IBS.Subjects and Methods90 patients between 18 to 65 years, with a diagnosis of IBS as per Rome III criteria, were included. Celiac disease and wheat allergy were excluded appropriately. Patients fulfilling the inclusion criteria were given gluten free diet for 4 weeks and patients followed weekly. The patients were interviewed for symptoms at baseline and weekly for 4 weeks, and compared on 100 mm visual analogue scale. Study population was again given normal gluten containing diet to look for reappearance of the symptoms. Analysis of quantitative data measured 3 times (baseline, 1 month after GFD after re-challenge) was done using Friedman RM ANOVA on Ranks and Appropriate Post Hoc test was used.ResultsMales outnumbered the females in the study. On a visual analogue scale, 3 patients showed significant improvement with gluten free diet for overall symptoms (P < .05), pain (P < .05), bloating P < .05), satisfaction with stool consistency (P < .05). On gluten rechallenge after completion of 4 weeks, patient symptom deterioration occurred in days to week duration.ConclusionsOur data identifies a patient population suffering from non-celiac gluten sensitivity.LimitationsRandomized double-blind placebo controlled study would have been better approach. The present study is limited with low sample size. BackgroundSpectrum of gluten-related disorders got a new entity, represented by gluten sensitivity. Clinical picture is a combination of IBS (irritable bowel syndrome) symptoms and of systemic manifestations. No strict criteria for the diagnosis of NCGS exist, prevalence claimed to be up to 6%. Spectrum of gluten-related disorders got a new entity, represented by gluten sensitivity. Clinical picture is a combination of IBS (irritable bowel syndrome) symptoms and of systemic manifestations. No strict criteria for the diagnosis of NCGS exist, prevalence claimed to be up to 6%. ObjectivesTo study the prevalence of non-celiac gluten sensitivity (NCGS) and response to dietary intervention in IBS. To study the prevalence of non-celiac gluten sensitivity (NCGS) and response to dietary intervention in IBS. Subjects and Methods90 patients between 18 to 65 years, with a diagnosis of IBS as per Rome III criteria, were included. Celiac disease and wheat allergy were excluded appropriately. Patients fulfilling the inclusion criteria were given gluten free diet for 4 weeks and patients followed weekly. The patients were interviewed for symptoms at baseline and weekly for 4 weeks, and compared on 100 mm visual analogue scale. Study population was again given normal gluten containing diet to look for reappearance of the symptoms. Analysis of quantitative data measured 3 times (baseline, 1 month after GFD after re-challenge) was done using Friedman RM ANOVA on Ranks and Appropriate Post Hoc test was used. 90 patients between 18 to 65 years, with a diagnosis of IBS as per Rome III criteria, were included. Celiac disease and wheat allergy were excluded appropriately. Patients fulfilling the inclusion criteria were given gluten free diet for 4 weeks and patients followed weekly. The patients were interviewed for symptoms at baseline and weekly for 4 weeks, and compared on 100 mm visual analogue scale. Study population was again given normal gluten containing diet to look for reappearance of the symptoms. Analysis of quantitative data measured 3 times (baseline, 1 month after GFD after re-challenge) was done using Friedman RM ANOVA on Ranks and Appropriate Post Hoc test was used. ResultsMales outnumbered the females in the study. On a visual analogue scale, 3 patients showed significant improvement with gluten free diet for overall symptoms (P < .05), pain (P < .05), bloating P < .05), satisfaction with stool consistency (P < .05). On gluten rechallenge after completion of 4 weeks, patient symptom deterioration occurred in days to week duration. Males outnumbered the females in the study. On a visual analogue scale, 3 patients showed significant improvement with gluten free diet for overall symptoms (P < .05), pain (P < .05), bloating P < .05), satisfaction with stool consistency (P < .05). On gluten rechallenge after completion of 4 weeks, patient symptom deterioration occurred in days to week duration. ConclusionsOur data identifies a patient population suffering from non-celiac gluten sensitivity. Our data identifies a patient population suffering from non-celiac gluten sensitivity.

Non-celiac gluten hypersensitivity: What is all the fuss about?

Non-celiac gluten sensitivity (NCGS) has been introduced recently as a potentially common disease on the basis of studies of patients with claimed reactivity to gluten but without the characteristics of celiac disease (CD). CD is characterized by antibody reactivity toward the autoantigen transglutaminase 2, characteristic histological abnormalities of the small intestine, and an almost obligatory genetic haplotype (HLA-DQ2 or DQ8). The diagnosis of NCGS is based largely on the clinical suspicion of hyper-reactivity to gluten and the absence of the characteristics of CD. Few published studies have used double-blind placebo-controlled food challenges (DBPCFCs) for the diagnosis of NCGS, and none in children. Innate immune reactivity to amylase trypsin inhibitors has been suggested as the pathogenic principle in NCGS, but confirmatory evidence is lacking. Also, further clinical studies including DBPCFCs are needed.

Pentraxin 3 serum levels in celiac patients: evidences and perspectives.

Celiac disease (CD) is now considered, more than a just gluten sensitivity enteropathy, a multiple and systemic immune-mediate disorder triggered by the ingestion of wheat gluten and related proteins. Following the discovery of a link between gluten and CD, it was demonstrated that gliadin, one of the two principal protein groups comprising gluten, plays a key role in CD. It has since become clear that the different and crucial roles of gliadin in CD result from its ability to activate multiple signaling pathways that modulate CD pathology. Most of these pathways involve the host innate and adaptive immune responses, but some pathways are activated when gliadin interacts with the intestinal cellular compartment. The long pentraxin (PTX3), a marker of the acute-phase inflammatory response, plays an important role in innate immunity and in modulation of the adaptive immune response. We investigated whether CD patients, considered as a model of gluten-sensitivity condition, have increased PTX3 levels. Our data showed that PTX3 serum levels were high in active CD patients and serum levels of PTX3 correlated with DGP IgA levels. We provide evidences that the bad compliance of GFD in patients 2 concurred with a pathological PTX3 concentration that could follow the improvement of both gastrointestinal and extraintestinal symptoms. We hypothesized that PTX3 is able to modulate the innate response to gliadin in CD and it could regulate the adaptive immune response. It is also evidenced that a common "wooden horse" of CD and Non Celiac Gluten Sensitivity (NCGS) is the ingestion of gluten and related toxic peptides. At the moment we don't have adequate elements to suggest the use of PTX3 in diagnosis of NCGS, but we are obliged to speculate about the possible role of PTX3 molecules in NCGS pathogenesis. The identified new strategies and uses of PTX3 could improve the management of gluten sensitivity conditions in the next future.

Mutatis mutandis: Are we diagnosing too many people with non-celiac gluten sensitivity? Multiple case report

We report three patients presenting with gluten-related signs and symptoms. Since villous height/crypt depth ratio, intraepithelial lymphocyte count, and serum antibody tests were not diagnostic for celiac disease (CD), a diagnosis of non-celiac gluten sensitivity (NCGS) was suggested. On the other hand, antibodies suggestive for CD surprisingly showed positive results in the duodenal biopsy organ culture of all three cases. The reported cases suggest the precious potential role that organ culture systems may play in differentiating CD from NCGS. This method should be recommended when gluten-related disorders are suspected in order to reduce the inappropriate diagnosis of NCGS.

Gluten Sensitivity in Pediatrics: A Clinical Conundrum

Non-celiac gluten sensitivity (NCGS) is a condition in which symptoms are triggered by gluten ingestion, in which both allergic and autoimmune mechanisms have been ruled out. The “classical” presentation of NCGS is a combination of gastrointestinal symptoms (including abdominal pain, bloating, and bowel habit abnormalities) and extra-intestinal manifestations. So far, NCGS has been described extensively in adults, and few data are available for the pediatric population. Due to lack of a serological or histological marker, the diagnosis of NCGS remains clinical and it is based on the exclusion of celiac disease and wheat allergy and on gluten challenge. G is a 2.5-year-old child referred to our Center for chronic diarrhea, diurnal abdominal pain, and mild failure to thrive. His mother reported that symptoms were related to wheat ingestion and that resolved on a gluten-free diet; therefore, she was worried about Celiac Disease. However, blood tests did support neither celiac disease because of anti-transglutaminase-IgA, anti-endomysium, and anti-gliadin-IgA negativity nor wheat allergy for the absence of specific IgE for wheat or gluten. G was positive just to anti-gliadin-IgG. We reassured the mother and concluded for a chronic unspecific diarrhea to be treated conservatively without elimination diets. On the follow-up visit, G was still complaining with same symptoms, and his growth was further slowing; we ,therefore, decided to repeat the blood tests (with similar results), to define the HLA status (DQ1/7), and to perform intestinal duodenal biopsies. These showed normal villous architecture and a modest increase of intraepithelial lymphocytes. Based on the clear association between clinical symptoms and wheat ingestion, the final diagnosis was “non IgE-mediated adverse reaction to wheat,” although G had no other clue to support this diagnosis such as personal or family history of atopy and/or eczema. G was started on a gluten-free diet with resolution of symptoms. This diagnosis was confirmed 6 months later with a double-blind placebo-controlled challenge that resulted in the onset of diarrhea and abdominal pain 30 h after wheat ingestion. This was happening in 2006 and 2 years later a “new” disease entity might have better explained the symptoms of this child: NCGS.

Sensibilidad al gluten no celiaca: una revisión crítica de la evidencia actual

Non-celiac gluten sensitivity (NCGS) is an emerging disorder characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food in non-celiac patients. Its prevalence has been estimated to be six to ten-times higher than that of celiac disease (CD). A gluten-free diet is the most widely recommended therapy, but the causative agent remains unknown and there are no consensus diagnostic criteria. Recent studies on NCGS have included patients with possibly overlooked minor CD and diarrhea-predominant irritable bowel syndrome without self-reported gluten intolerance, but showing a response to a gluten-free diet. Furthermore, FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols) have recently been postulated as the culprit component for NCGS in wheat, instead of gluten. This review updates evidence on the pathophysiology of NCGS and the efficacy of different dietary interventions in its treatment, stressing the need for proper screening for CD before a diagnosis of NCGS is made.