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Non-coeliac gluten sensitivity (NCGS) occurs with very non-specific symptoms that resemble those of coeliac disease or wheat allergy and can have both intestinal and extraintestinal manifestations. There is also overlap between the symptoms of NCGS and irritable bowel syndrome.

As with coeliac disease, the symptoms of NCGS are very diverse and the clinical picture is very broad. This means that it is not possible to distinguish between different gluten-related complaints on the basis of symptoms alone. Symptoms related to NCGS can vary from typical gastrointestinal complaints including diarrhoea, abdominal pain and bloating to extra intestinal manifestations including fatigue, headaches and joint pain. Some patients may be able to tolerate a small amount of gluten without developing clinical symptoms. In contrast to coeliac disease patients, strict gluten avoidance may not therefore be necessary. The list below illustrates the intestinal and extraintestinal symptoms that can manifest in NCGS patients.

Common symptoms of NCGS

Gastrointestinal complaints Gastrointestinal complaints
Bloating Lack of well-being
Abdominal pain Fatigue
Diarrhoea or constipation Headaches
Upper abdominal pain Anxiety
Nausea Mental confusion ("foggy mind")
Gastro-oesophageal reflux Numbness in arms and legs
Aphthous stomatitis Fibromyalgia-like joint and muscle pain
Heartburn or vomiting Dermatitis/rashes
Glossitis Anaemia
Sources: Volta et al. BMC Medicine 2014, 12:85; A. Fasano, Center for Celiac Research & Treatment, Baltimore, USA


Catassi et al. Diagnosis of Non-Celiac Gluten Sensitivity (NCGS): The Salernos Experts' Criteria. Nutrients 2015, 7(6), 4966-4977