Understanding and managing non-coeliac gluten sensitivity: "We are all on a learning curve", says UK expert

Date: Oct-17-2013The newly-emerged clinical syndrome non-coeliac gluten sensitivity continues to puzzle gastroenterologists and other medical professionals, as scientists and clinicians grapple to understand the condition and how best to manage it. Professor David Sanders from the Sheffield Teaching Hospitals in Sheffield, UK, and Chairman of the Health Advisory Committee for
the respected UK charity Coeliac UK, told journalists at the 21st United European
Gastroenterology Week (UEG Week) in Berlin, Germany, that a careful diagnosis
to exclude coeliac disease, good patient education and cautious use of a glutenfree diet may be key to effective symptom control in this condition. "Public awareness of gluten-related symptoms is rising, if not mushrooming," he said. "But we shouldn't rush into prescribing a gluten-free diet to everyone who reports gluten sensitivity. We are still on a learning curve ourselves about this
condition and its natural history, and patients need to understand that."

What is non-coeliac gluten sensitivity?

Until relatively recently, the most well-known medical condition associated with gluten
sensitivity was coeliac disease. This is caused by an immune response to the cereal
protein gluten in susceptible people. Coeliac disease is a potentially serious condition
that can cause intestinal symptoms such as weight loss and chronic diarrhoea and other
health problems including anaemia, osteoporosis, joint pain, dermatitis and neurological
symptoms. The condition affects around 1% of the general population and is diagnosed
using a combination of a blood test for antibodies and a biopsy of the small intestine.1 A
life-long gluten-free diet is currently the only treatment available.

It is now widely accepted that gluten sensitivity can also occur in people without coeliac
disease. Non-coeliac gluten sensitivity (NCGS), as it is known, is associated with a
similar range of acute symptoms to coeliac disease, making it difficult to differentiate
between the two conditions based on symptoms alone. NCGS is diagnosed by a
process of exclusion and currently there is no biomarker to detect it. It seems likely that
NCGS is far more prevalent than coeliac disease, with a recent UK study2 suggesting
that, out of every 100 patients with gluten sensitivity referred for specialist investigation,
10 will be diagnosed with coeliac disease and 90 will have NCGS.

"In this study, 13% of adults screened in the general population said they had gluten
sensitivity, which is a significant number of people," said Prof. Sanders. "We were very
interested to find that the vast majority of individuals referred to secondary care with
gluten sensitivity were diagnosed with NCGS and that these people were far less likely
to have nutritional deficiencies or autoimmune disorders than the patients diagnosed
with coeliac disease."

Prof. Sanders thinks the best way for doctors to approach patients who present with
symptoms relating to eating gluten is to focus on excluding coeliac disease using blood
tests and, where necessary, gastroscopy with a biopsy of the small bowel. However, he
says, physicians need to make sure patients are eating a normal diet at the time of
diagnosis. "Any patient who presents saying they have gluten-related symptoms is likely
to have placed themselves on a gluten-free diet," he says. "It is essential that these
patients stop their gluten-free diet and eat a normal diet in order for us to exclude
coeliac disease."

What role for a gluten-free diet in NCGS?

Gluten-free product sales far exceed the number of patients diagnosed with coeliac
disease, suggesting that many individuals are deriving symptomatic benefit from a 2 of 2
gluten-free diet. However, says Prof. Sanders, in his opinion, a gluten-free diet should
not be prescribed immediately to individuals diagnosed with NCGS.

"I believe we should reassure patients that they do not have coeliac disease and
therefore their risk of complications is lower," he said. "We should explain that we, as
doctors, are still learning about this condition before discussing with them the possible
role of a gluten-free diet in the future. Depending on how symptoms progress after the
diagnosis, patients may choose to reintroduce a gluten-free diet at a later date or they
may be able to gradually increase their gluten intake."

Courtesy: Medical News Today Note: Any medical information available in this news section is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.