Treatment of non-celiac gluten sensitivity

  1. Dr.Schär Institute
  2. Dr. Schär Institute
  3. Treatment of non-celiac gluten sensitivity

As with celiac disease, the therapy for non-celiac gluten sensitivity (NCGS) is to avoid gluten. However, it is not generally necessary to maintain a gluten-free diet as strictly or for as long as with celiac disease. It is important that the patient only begins a gluten-free diet after the diagnosis is confirmed.

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In the context of diagnosis a gluten-free diet represents an important criterion for confirming NCGS. If neither celiac disease nor wheat allergy are present, a trial gluten-free diet may be introduced. If the symptoms improve within a two week period, and then occur again after a gluten challenge, NCGS is likely to be confirmed. The patient should only switch to a gluten-free diet once the diagnosis is confirmed.

Low-gluten rather than gluten-free

It has been demonstrated that patients with NCGS may be able to tolerate a small amount of gluten without developing symptoms [1]. After one or two years of a gluten-free diet, patients with NCGS can attempt to reintroduce small amounts of gluten. In contrast to celiac disease, a strict gluten-free diet is therefore not mandatory in cases of NCGS; a low-gluten diet may be sufficient to avoid symptoms. How much gluten can be eaten without any problems must be tested individually. The fact that it is not necessary to maintain a permanent gluten-free diet is a crucial difference to celiac disease, which requires strict lifelong maintenance of a gluten-free diet.
 

Amylase-trypsin inhibitors as a possible trigger

There is currently a lack of research to confirm whether gluten is the trigger of symptoms amongst patients with NCGS, or whether other fractions within gluten-containing cereal grains e.g. amylase-trypsin inhibitors (ATIs) – primarily found in wheat , are to blame [2]. Because gluten-free foods are naturally wheat-free and thus contain no ATIs, a gluten-free or low-gluten diet is generally the recommended therapy option for patients with NCGS.

FODMAPs as a possible trigger

There are suspected NCGS patients who do not respond to a gluten-free diet. Studies have indicated that a low-FODMAP diet improves symptoms in some patients with irritable bowel syndrome (IBS) [3], therefore an alternative diagnosis of IBS, treated by a low-FODMAP diet may yield results for such patients.

References

  1. Al-Toma A, Volta U, Auricchio R, Castillejo G, Sanders DS, Cellier C, Mulder CJ, Lundin KEA. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J. 2019 Jun;7(5):583-613. doi: 10.1177/2050640619844125. Epub 2019 Apr 13. PMID: 31210940; PMCID: PMC6545713.
  2. Junker, Y. et al. Wheat amylase trypsin inhibitors drive intestinal inflammation via activation of toll-like receptor 4. J. Exp. Med. 209, 2395–2408 (2012).
  3. Biesiekierski, J. R. et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology 145, 320–328 (2013).
  4. Catassi C, Elli L et al. Diagnosis of Non-Celiac Gluten Sensitivity (NCGS): The Salerno Experts' Criteria. Nutrients. 2015 Jun 18;7(6):4966-77.