Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2015; 21(27): 8221-8226
Published online Jul 21, 2015. doi: 10.3748/wjg.v21.i27.8221
Non-celiac gluten sensitivity: Time for sifting the grain
Luca Elli, Leda Roncoroni, Maria Teresa Bardella
Luca Elli, Leda Roncoroni, Maria Teresa Bardella, Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
Author contributions: Elli L, Roncoroni L and Bardella MT contributed equally to this paper.
Conflict-of-interest statement: The authors declare no conflict of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Luca Elli, MD, PhD, Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy. dottorlucaelli@gmail.com
Telephone: +39-2-55033384 Fax: +39-2-55033664
Received: January 23, 2015
Peer-review started: January 23, 2015
First decision: March 10, 2015
Revised: April 1, 2015
Accepted: May 27, 2015
Article in press: May 27, 2015
Published online: July 21, 2015
Processing time: 180 Days and 6 Hours
Abstract

In the last few years, a new nomenclature has been proposed for the disease induced by the ingestion of gluten, a protein present in wheat, rice, barley and oats. Besides celiac disease and wheat allergy, the most studied forms of gluten-related disorders characterized by an evident immune mechanism (autoimmune in celiac disease and IgE-mediated in wheat allergy), a new entity has been included, apparently not driven by an aberrant immune response: the non-celiac gluten sensitivity (NCGS). NCGS is characterized by a heterogeneous clinical picture with intestinal and extraintestinal symptoms arising after gluten ingestion and rapidly improving after its withdrawal from the diet. The pathogenesis of NCGS is largely unknown, but a mixture of factors such as the stimulation of the innate immune system, the direct cytotoxic effects of gluten, and probably the synergy with other wheat molecules, are clues for the complicated puzzle. In addition, the diagnostic procedures still remain problematic due to the absence of efficient diagnostic markers; thus, diagnosis is based upon the symptomatic response to a gluten-free diet and the recurrence of symptoms after gluten reintroduction with the possibility of an important involvement of a placebo effect. The temporary withdrawal of gluten seems a reasonable therapy, but the timing of gluten reintroduction and the correct patient management approach are have not yet been determined.

Keywords: Celiac disease; Gluten; Gluten-related disorders; Gluten sensitivity; Non-celiac gluten sensitivity

Core tip: Gluten-related disorders are extremely relevant in gastroenterologic practice, and their prevalence has increased in recent decades. Besides celiac disease and allergy, the newly born non-celiac gluten sensitivity is still an obscure syndrome with an unknown pathogenesis and important clinical concerns regarding diagnosis and patient management.