A Clinical Update: Nonceliac Gluten Sensitivity—Is It Really the Gluten?

• Although celiac disease (CD) affects up to 1% of the US population, an entity known as nonceliac “gluten sensitivity” (NCGS) is estimated at between 0.55% and 6%.
• NCGS is an entity distinct from CD and is defined as a nonallergic and non-autoimmune condition in which the consumption of gluten can lead to symptoms similar to those seen in CD.
• NCGS manifests as gastrointestinal (GI) and/or non-GI symptoms which occur after the ingestion of gluten, with improvement after gluten withdrawal from the patient’s diet.
• Many patients are self-reporting and suspecting “gluten sensitivity” after GI symptoms, such as bloating, abdominal pain, or diarrhea, resolve on a gluten-free diet without formal evaluation testing for food allergies or CD.
• Without the proper knowledge or supervision, a gluten-free diet can be low in fiber, high in fat and calories, and low in vitamins and minerals.
• It remains unclear whether gluten proteins are in fact the sole molecules or whether nongluten proteins of wheat are partially, or wholly, responsible for the associated symptoms.

Gluten-free diets are increasing in popularity among consumers and fueling a global market of gluten-free products. A gluten-free diet is the only treatment for celiac disease (CD). However, many patients are self-reporting and suspecting “gluten sensitivity” after gastrointestinal symptoms, such as bloating, abdominal pain, or diarrhea, resolve on a gluten-free diet without formal evaluation testing for food allergies or CD. The terms related to gluten and/or wheat intolerance, nonceliac gluten sensitivity or wheat sensitivity, CD, and wheat allergy can be confusing. These forms of intolerance combined affect approximately 10% of the United States population. In this article we clarify the range of gluten and/or wheat disorders, clinical features, diagnosis, and management.