Nonceliac Gluten and Wheat Sensitivity: Review

A Khan et al. Clin Gastroenterol Hepatol 2020; 18: 1913-1922. Nonceliac Gluten and Wheat Sensitivity

This useful review notes that ” there is a great deal of skepticism within the scientific community questioning the existence of NCGS as a distinct clinical disorder.”

Key points:

  • The pathogenesis of NCGS is unclear and there is no known biomarker or diagnostic histologic lesion for this condition.
  • In these suspected patients, it is important to first exclude celiac disease and wheat allergy (especially if a rash with eating). If celiac disease is identified, this allows for appropriate longitudinal followup, strict dietary instructions, and potential screening of at-risk family members.
  • Recent studies have shown that GI symptoms in those labelled with NCGS are frequently due to dietary FODMAPs.
  • In a large meta-analysis study with 1312 adults, only 16% of participants experience gluten-specific symptoms using a double-blind placebo-controlled rechallenge.  In addition, 40% of participants experienced a nocebo response (ie. a greater negative effect than usual due to negative expectation from a dietary treatment)
  • In clinical practice, a single blind placebo-controlled rechallenge trial has been recommended for diagnosis

My take: GFD is often unnecessary and ineffective, even in those who have previously identified gluten as a potential food trigger.  Fructans are more likely to induce gastrointestinal symptoms.

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