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Non-celiac gluten sensitivity:Time for sifting the grain

World Journal of Gastroenterology 2015年第27期21卷 8221-8226页

作者： Luca Elli Leda Roncoroni Maria Teresa Bardella Center for Prevention and Diagnosis of Celiac Disease Gastroenterology and Endoscopy Unit Department of Pathophysiology and Transplantation Università degli Studi di Milano. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico

In the last few years, a new nomenclature has been proposed for the disease induced by the ingestion of gluten, a protein present in wheat, rice, barley and oats. Besides celiac disease and wheat allergy, the most studied forms of gluten-related disorders characterized by an evident immune mechanism(autoimmune in celiac disease and Ig E-mediated in wheat allergy), a new entity has been included, apparently not driven by an aberrant immune response: the non-celiac gluten sensitivity(NCGS). NCGS is characterized by a heterogeneous clinical picture with intestinal and extraintestinal symptoms arising after gluten ingestion and rapidly improving after its withdrawal from the diet. The pathogenesis of NCGS is largely unknown, but a mixture of factors such as the stimulation of the innate immune system, the direct cytotoxic effects of gluten, and probably the synergy with other wheat molecules, are clues for the complicated puzzle. In addition, the diagnostic procedures still remain problematic due to the absence of efficient diagnostic markers; thus, diagnosis is based upon the symptomatic response to a gluten-free diet and the recurrence of symptoms after gluten reintroduction with the possibility of an important involvement of a placebo effect. The temporary withdrawal of gluten seems a reasonable therapy, but the timing of gluten reintroduction and the correct patient management approach are have not yet been determined.

关键词： Celiac disease gluten gluten-relateddisorders gluten sensitivity Non-celiac gluten sensitivity

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