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Professional resource for gluten free nutrition.

Dr. Schär Institute

Definition of non-coeliac gluten sensitivity

Non-coeliac gluten sensitivity (NCGS) presents with non-specific symptoms that occur both intestinally and extra-intestinally and resemble the symptoms of coeliac disease or wheat allergy. Diagnosis is made based on the response to a gluten-free diet, after coeliac disease and wheat allergy have been ruled out.
There is a group of patients who respond to the consumption of food containing gluten with symptoms such as abdominal pain, fatigue, headaches, rashes, or mental confusion ("foggy mind"). However, neither coeliac 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-coeliac wheat sensitivity.

Differences in comparison to coeliac disease and wheat allergy

All three gluten-related disorders - NCGS, coeliac disease and wheat allergy - have similar symptoms and are therefore easily confused. However, there are differences, e.g. in terms of reaction times and pathogenesis. Coeliac 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 coeliac disease after eating food containing gluten, the clinical picture is generally less severe and it is not possible to determine auto-antibodies, anti-tissue-transglutaminases or autoimmune concomitant diseases. In contrast to coeliac 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.

Overview of how to distinguish between coeliac disease, NCGS and wheat allergy

  Coeliac 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) Negative
(except anti-gliadin antibodies IgA and/or IgG)
Enteropathy Typical Missing; occasionally IEL slightly elevated (Marsh 0-1) Missing
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 coeliac disease may must avoid foods containing gluten, even those that contain only traces of gluten, for their entire life
The gluten-free diet may be for a limited time

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
Dr. Schär Institute Overview of gluten-related diseases Gluten intolerance
Overview of gluten-related diseases
Overview of gluten-related diseases from wheat allergy and coeliac disease to gluten sensitivity

Further information on this topic

Presentations 2

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Expert interviews 5

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Coeliac Disease and Gluten Related Disorders in Russia and Former Soviet Republics (2015)

Elena Roslavtseva, MD, Ph.D.
Scientific Center for Children’s Health, Moscow

16th International Coeliac Disease Symposium 2015 in Prague
Pre-Conference Workshop on Gluten Sensitivity "The Evolving Planet of Gluten Related Disorders"

Pre Conference Workshop on Gluten Sensitivity (2013)

Alessio Fasano, M.D.
Medical Director
Mucosal Immunology and Biology Research Center and Center for Celiac Research
Massachusetts General Hospital
Boston MA, USA

15. International Celiac Disease Symposium in Chicago between the 22nd and 25th September 2013

Non-Coeliac Gluten Sensitivity in Adult & Paediatric Patients

Professor Carlo Catassi
Gastroenterologist Pediatrician
Department of Pediatrics
Università Politecnica delle Marche
60123 Ancona, Italy

At the Expert Meeting 2014 in Salerno, Italy.

Gluten Sensitivity – Definition, Symptoms and Differences to Coeliac Disease

International Expert Meeting on Gluten Sensitivity 2012 in Munich, Germany

New Insights from the Second Expert Meeting on Gluten Sensitivity

International Expert Meeting on Gluten Sensitivity 2012 in Munich, Germany

Key Messages for Healthcare Professionals on Gluten Sensitivity

International Expert Meeting on Gluten Sensitivity 2012 in Munich, Germany

Management of Gluten Sensitivity: the Role of the Gluten-Free Diet

International Expert Meeting on Gluten Sensitivity 2012 in Munich, Germany