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.