Is Gluten a Cause of Gastrointestinal Symptoms in People Without Celiac Disease?
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The avoidance of wheat- and gluten-containing products is a worldwide phenomenon. While celiac disease is a well-established entity, the evidence base for gluten as a trigger of symptoms in patients without celiac disease (so-called ‘non-celiac gluten sensitivity’ or NCGS) is limited. The problems lie in the complexity of wheat and the ability of its carbohydrate as well as protein components to trigger gastrointestinal symptoms, the potentially false assumption that response to a gluten-free diet equates to an effect of gluten withdrawal, and diagnostic criteria for coeliac disease. Recent randomized controlled re-challenge trials have suggested that gluten may worsen gastrointestinal symptoms, but failed to confirm patients with self-perceived NCGS have specific gluten sensitivity. Furthermore, mechanisms by which gluten triggers symptoms have yet to be identified. This review discusses the most recent scientific evidence and our current understanding of NCGS.
KeywordsGluten sensitivity Celiac disease Irritable bowel syndrome Wheat Gastrointestinal symptoms Fodmaps Food hypersensitivity
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Conflict of Interest
Jessica R. Biesiekierski, Jane G. Muir, and Peter R. Gibson declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with animal subjects performed by the authors. With regard to the authors’ research cited in this paper, all procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000 and 2008.
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