Non-celiac gluten sensitivity (NCGS) is still an undefined syndrome with several unsettled issues despite the increasing awareness of its existence.
In recent years, a growing number of subjects worldwide have reported that ingestion of wheat and, to a lesser extent, of other cereals such as barley, rye, and spelt cause them intestinal and extraintestinal symptoms without the diagnostic features of celiac disease (CD) or wheat allergy (WA). This self-reported wheat sensitivity has fueled the debate on the possible existence of a new syndrome, which has been recently named as non-celiac gluten sensitivity (NCGS) to differentiate it from Celiac Disease.
Gluten, the main protein complex contained not only in wheat, but also in barley, rye, and spelt, has been identified as the possible trigger of this syndrome. Indeed, it has been suggested that wheat proteins other than gluten, such as amylase trypsin inhibitors, can contribute to this disorder.
In addition, recent studies have emphasized the possible role of fermentable oligosaccharides, monosaccharides and disaccharides and polyols (FODMAPs) in the development of this syndrome. Interestingly, together with milk, legumes, honey, some fruits (watermelon, cherry, mango, pear) and some vegetables (chicory, fennel, beetroot, and leek), the most common food sources of FODMAPs also include wheat and rye, the same grains and cereals that also contain gluten proteins.
Despite awareness of these limitations, for the time being the acronym NCGS has been accepted by the scientific community, and it is commonly used to indicate this syndrom.
NCGS may be a frequent finding among patients referred to centers for the diagnosis of gluten-related disorders. This new gluten-induced syndrome appears to have a strong correlation with female gender and adult age, and has a prevalence that might be slightly higher than that of CD, but is certainly far lower than that hypothesized on the basis of previous reports.
Gastrointestinal symptoms in suspected non-celiac gluten sensitivity (NCGS):
Bloating, abdominal pain, diarrhea, epigastric pain, nausea, aerophagia, gastrooesophageal reflux, aphthous stomatitis, alternating boel habits, constipation
Extraintestinal manifestations in suspected non-celiac gluten sensitivity (NCGS):
Lack of well being, tiredness, headache, anxiety, foggy mind, numbness, joint / muscle pain, skin rash, weight loss, anemia, depression, dermatitis, rhinitis, asthma
Disorders associated to suspected non-celiac gluten sensitivity (NCGS):
Irritable bowel syndrome, food intolerance, allergy, autoimmune disorders, eating behavior disorders