Definition of non-celiac gluten sensitivity

  1. Dr.Schär Institute
  2. Gluten Free
  3. Definition of non-celiac gluten sensitivity
Weizenmehl auf dem Tisch

Non-celiac gluten sensitivity (NCGS) manifests itself with non-specific symptoms that occur both intestinally and extra-intestinally and resemble the symptoms of celiac disease or wheat allergy. Diagnosis is made based on the response to a gluten-free diet, after celiac disease and wheat allergy have been ruled out.

There is a group of patients who react to the consumption of food containing gluten with symptoms such as abdominal pain, fatigue, headaches, rashes, or mental confusion ("foggy mind"). However, neither celiac disease nor wheat allergy is present in these instances. When these patients avoid gluten, their symptoms improve within a few weeks; when they are re-exposed to gluten the symptoms return. Whether the gluten or some other component of wheat is actually responsible for the reactions is currently the subject of debate in the scientific community. The focus is not just on gluten, it also includes amylase trypsin inhibitors (ATI) and FODMAPs. For this reason, some experts in this field may refer to NCGS more broadly as non-celiac wheat sensitivity.

Differences between celiac disease and wheat allergy

All three gluten-related disorders - NCGS, celiac disease and wheat allergy - have similar symptoms and therefore diagnosis can be difficult. However, there are differences both in terms of reaction times and pathogenesis. Celiac disease is an autoimmune enteropathy caused by gluten. Wheat allergy is an IgE-mediated response to wheat. Although people with NCGS develop symptoms similar to those observed in celiac disease after eating food containing gluten, the clinical presentation is generally less severe. However, in contrast to celiac disease, individuals with NCGS usually do not present with auto-antibodies, anti-tissue-transglutaminases or autoimmune concomitant diseases. In contrast to celiac disease patients, patients with NCGS exhibit little histological change or only lesions in the small intestine mucosa, which corresponds to 0 - 1 on the Marsh scale.


How to distinguish between celiac disease, NCGS and wheat allergy

Celiac disease Gluten sensitivity Wheat allergy
Period between exposure to gluten and onset of symptoms Weeks to years Hours to days Immediate reaction:
a few hours
Delayed reaction:
a few hours to two days
Pathogenesis Autoimmune
(congenital + adaptive immunity)
Currently unclear immunological reaction IgE formation and IgE-mediated mediator release
(approx. 95% of cases)
Unclear -
Autoantibodies Positive
(high sensitivity and specificity)
(except anti-gliadin antibodies IgA and/or IgG)
Enteropathy Typical Missing; occasionally IEL slightly elevated
(Marsh 0-1)
Symptoms Intestinal and extra-intestinal Intestinal and extra-intestinal Intestinal and extra-intestinal
Complications Concomitant diseases, long-term complications No concomitant diseases, long-term complications unknown No concomitant diseases
Therapy Long-term implementation of a gluten-free diet is necessary

Persons with celiac disease may must avoid foods containing gluten, even those that contain only traces of gluten, for their entire life
The minimum time frame should be no less than one or two years

The minimum time frame should be no less than one or two years

The tolerance threshold of patients with NCGS varies, i.e. gluten intake must be adjusted individually
Temporary avoidance of wheat-based foods is sometimes sufficient

Administration of cortisone may be necessary