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 11 December 2017

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News

Celiac disease and nonceliac gluten sensitivity

This week's issue of the Journal of the American Medical Association examines the screening, diagnosis, and treatment for celiac disease and nonceliac gluten sensitivity.

News image

The prevalence of gluten-related disorders is rising, and increasing numbers of individuals are empirically trying a gluten-free diet for a variety of signs and symptoms.

Dr Leonard and colleagues review current evidence regarding screening, diagnosis, and treatment for celiac disease and nonceliac gluten sensitivity.

Celiac disease is a gluten-induced immune-mediated enteropathy characterized by a specific genetic genotype, and autoantibodies.

Although the inflammatory process specifically targets the intestinal mucosa, patients may present with gastrointestinal signs or symptoms, extraintestinal signs or symptoms, or both, suggesting that celiac disease is a systemic disease.

The team report that nonceliac gluten sensitivity is diagnosed in individuals who do not have celiac disease or wheat allergy but who have intestinal symptoms, extraintestinal symptoms, or both, related to ingestion of gluten-containing grains, with symptomatic improvement on their withdrawal.

Clinicians cannot distinguish between celiac disease and nonceliac gluten sensitivity by symptoms
Journal of the American Medical Association

The researchers found that clinical variability and the lack of validated biomarkers for nonceliac gluten sensitivity make establishing the prevalence, reaching a diagnosis, and further study of this condition difficult.

The team report that it is still possible to differentiate specific gluten-related disorders from other conditions, based on currently available investigations and algorithms.

Clinicians cannot distinguish between celiac disease and nonceliac gluten sensitivity by symptoms, as they are similar in both.

The team emphasise that screening for celiac disease must occur before a gluten-free diet is implemented, since once a patient initiates a gluten-free diet, testing for celiac disease is no longer accurate.

Dr Leonard's team comments, "Celiac disease and nonceliac gluten sensitivity are common."

"Although both conditions are treated with a gluten-free diet, distinguishing between celiac disease and nonceliac gluten sensitivity is important for long-term therapy."

"Patients with celiac disease should be followed up closely for dietary adherence, nutritional deficiencies, and the development of possible comorbidities."

JAMA 2017;318(7):647-656
16 August 2017

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