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Professional resource for gluten free nutrition.

Dr. Schär Institute

Treatment of non-coeliac gluten sensitivity

As with coeliac disease, the therapy for non-coeliac 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 in the case of coeliac disease. It is important that the patient only begins a gluten-free diet after the diagnosis.
In the context of diagnosis a gluten-free diet represents an important criterion for confirming NCGS. If neither coeliac 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 gluten intake, 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 coeliac 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 coeliac 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 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.
  1. 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.
  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).

Further information on this topic

Download 5

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Professional articles 2

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Presentations 2

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Studies 2

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Expert interviews 3

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Schar Pocket Sized Product Guide

A complete list of our Schär gluten free retail range, including allergen information, low FODMAP suitability and retailer listings.

Non-Coeliac Gluten Sensitivity Booklet

This resource provides healthcare professionals with a detailed overview of the current scientific evidence and understanding regarding non-coeliac gluten sensitivity. Definition, symptoms, diagnosis and treatment are amongst the topics covered as well as a number of practical case studies presented from expert clinicians in this field.

The new frontier of gluten-related disorders: Full Report from the 2nd Expert Meeting on Non-coeliac Gluten Sensitivity

This report, published in the journal ‘Nutrients’ evaluates and discusses major advances and current trends in non-coeliac gluten-sensitivity (NCGS) as well as areas where further research is required. It is the result of The Second Expert Meeting on Non-Coeliac Gluten Sensitivity which brought a panel of international experts together to discuss the evidence on gluten sensitivity, held in December 2012.

Short Report: Expert Meeting on Non-Coeliac Gluten Sensitivity 2012

Non-Coeliac Gluten Sensitivity. What precisely is this and what diagnosis criteria can be defined? Around 30 international experts discussed these questions in December 2012. A short report of the meeting is presented here.

Glutafin - Key Product Information and Ordering Codes

A comprehensive list of Glutafin products with their specific ordering codes, units per case, pack sizes, whether they are gluten free or gluten & wheat free, and key nutritional information.

Gut Microbiota in Health and Disease

As new evidence and better analytical techniques emerge, more information is becoming available about our gut bacteria. It is becoming clear that the type and relative amount of bacteria present in our gut plays an important role in both health and disease.

>> Read more... <<<
Wilson, B;

The Influence of the Microbiome on Gluten-Related Disorders

This short article provides an overview of the differences in microbiota which exist in gluten-related disorders, with a particular focus on coeliac disease. It goes on to outline a planned controlled prospective study which examines changes in intestinal microflora in patients with wheat sensitivity.

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Zopf, Y; Dieterich, W;

Gluten and functional gastrointestinal disorders: is it worth the challenge? (2015)

Luca Elli MD, PhD
Center for the Prevention and Diagnosis of Celiac Disease
Fondazione IRCCS Ca’ Granda
Ospedale Maggiore Policlinico, Milano, Italy

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

Non-Celiac Gluten Sensitivity: Patient Management (2013)

Daniel Leffler MD, MS
Director of Clinical Research
The Celiac Center
Beth Israel Deaconess Medical Center
Harvard Medical School
Boston MA, USA

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

Long- term response to gluten-free diet as evidence for non-celiac wheat sensitivity in one third of patients with diarrhoea- dominant and mixed-type irritable bowel syndrome

The aim of the study was to analyse if HLA-DQ2 and DQ8 are suitable markers for the diagnosis of wheat sensitivity (WS) and to evaluate the long-term clinical response to a GFD in a defined cohort of patients with IBS-D and IBS-M.

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Barmeyer, C; Schumann, M; Meyer, T; et al.;
2016 September

Effect of gluten free diet on immune response to gliadin in patients with non-celiac gluten sensitivity


Non-celiac gluten sensitivity is a syndrome characterized by gastrointestinal and extra-intestinal symptoms occurring in a few hours/days after gluten and/or other wheat protein ingestion and rapidly improving after exclusion of potential dietary triggers. There are no established laboratory markers for non-celiac gluten sensitivity, although a high prevalence of first generation anti-gliadin antibodies of IgG class has been reported in this condition. This study was designed to characterize the effect of the gluten-free diet on anti-gliadin antibodies of IgG class in patients with non-celiac gluten sensitivity.

Anti-gliadin antibodies of both IgG and IgA classes were assayed by ELISA in 44 non-celiac gluten sensitivity and 40 celiac disease patients after 6 months of gluten-free diet.

The majority of non-celiac gluten sensitivity patients (93.2%) showed the disappearance of anti-gliadin antibodies of IgG class after 6 months of gluten-free diet; in contrast, 16/40 (40%) of celiac patients displayed the persistence of these antibodies after gluten withdrawal. In non-celiac gluten sensitivity patients anti-gliadin antibodies IgG persistence after gluten withdrawal was significantly correlated with the low compliance to gluten-free diet and a mild clinical response.

Anti-gliadin antibodies of the IgG class disappear in patients with non-celiac gluten sensitivity reflecting a strict compliance to the gluten-free diet and a good clinical response to gluten withdrawal.

Resource: BMC Gastroenterol. 2014 Feb 13

Caio G, Volta U, Tovoli F, De Giorgio R
2014 February

What is the evidence for the duration of a gluten-free diet in IBS patients?

Reiner Ullrich, MD
Universitätsmedizin Berlin
Campus Benjamin Franklin,
Medizinische Klinik für Gastroenterologie
12203 Berlin, Germany

At the Expert Meeting 2014 in Salerno, Italy

What is the influence of a gluten-free diet on microbiota?

Professor Dr. med. Yurdagül Zopf
Internist, nutritional doctor
Univeristätsklinik Erlangen
91054 Erlangen, Germany

At the Expert Meeting 2014 in Salerno, Italy

Is there increasing demand for a gluten-free diet?

Professor Dr. med. Yurdagül Zopf
Internist, nutritional doctor
Univeristätsklinik Erlangen
91054 Erlangen, Germany

At the Expert Meeting 2014 in Salerno, Italy