Systematic review: noncoeliac gluten sensitivity

• Published in: Alimentary pharmacology & therapeutics Vol. 41; no. 9; pp. 807 - 820
• Main Authors: Molina‐Infante, J., Santolaria, S., Sanders, D. S., Fernández‐Bañares, F.
• Format: Journal Article
• Language: English
• Published: England 01.05.2015
• Subjects: Biomarkers - metabolism; Celiac Disease - diagnosis; Celiac Disease - diet therapy; Diarrhea - epidemiology; Diarrhea - etiology; Diet, Gluten-Free; Female; Food Hypersensitivity - diet therapy; Glutens - adverse effects; Humans; Irritable Bowel Syndrome - diet therapy; Male; Prevalence
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.13155

Summary Background Noncoeliac gluten sensitivity (NCGS) is a controversial emerging disorder. Despite reported symptoms related to the ingestion of gluten, NCGS remains a diagnosis based on the exclusion of coeliac disease, given the absence of reliable biomarkers. Aim To evaluate the prevalence, diagnostic exclusion of coeliac disease and the efficacy of a gluten‐free diet (GFD) for NCGS patients. Methods A PubMed search was performed up to December 2014. According to consensus diagnostic criteria, NCGS was defined as self‐reported gluten intolerance, negative coeliac serology and absence of villous atrophy. Studies evaluating the impact of a GFD on patients with irritable bowel syndrome (IBS) were also included. Results Prevalence rates of NCGS (0.5–13%) differed widely. Seventeen studies, including 1561 patients (26 children), met the inclusion criteria for NCGS. HLA haplotypes could not be linked to histology [normal or lymphocytic enteritis (LE)] in 1123 NCGS patients. HLADQ2/DQ8 haplotypes were present in 44% of NCGS patients. After advanced diagnostic techniques in 189 NCGS patients combining LE and HLADQ2/DQ8 haplotypes, 39 (20%) were reclassified as coeliac disease. There was a higher than expected family history of coeliac disease and autoimmune disorders in NCGS patients. A GFD resulted in variable results for variable, but significantly improved stool frequency in HLADQ2 positive diarrhoea‐predominant IBS patients. Conclusions Prevalence rates for NCGS are extremely variable. A subset of NCGS patients might belong in the so‐called ‘coeliac‐lite’ disease. The benefit of a GFD for NCGS patients is currently controversial. HLADQ2 positive diarrhoea‐type IBS patients might gain symptom improvement from a GFD.