Non-Celiac Gluten Sensitivity: A Challenging Diagnosis in Children with Abdominal Pain.
Study Goal
The researchers aimed to examine the clinical presentations, diagnostic challenges, and treatment efficacy of gluten-related disorders, particularly non-celiac gluten sensitivity (NCGS), and the role of a gluten-free diet.
Results Summary
The study found that NCGS lacks precise diagnostic tests or biomarkers, requiring a cumbersome gluten-exposure protocol for diagnosis. Symptoms improve on a gluten-free diet, but recent data suggest other wheat components, like fructans, may also trigger symptoms, indicating the term "gluten sensitivity" may be too restrictive.
Population
Children and adults with functional gastrointestinal complaints, particularly those with NCGS.
Effective Dosage
Not specified
Duration
Several weeks to months of gluten avoidance
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
gluten ingestion | increase | celiac disease | susceptible individuals | - | triggered | #1 |
gluten ingestion | increase | intestinal and extraintestinal symptoms | patients with non-celiac gluten sensitivity (NCGS) | - | occurring within hours, but sometimes even after several days | #2 |
gluten-free diet | decrease | symptoms elicited by gluten | patients with non-celiac gluten sensitivity (NCGS) | - | disappear | #3 |
mono- or oligosaccharides, such as fructan and other constituents of wheat | increase | GI symptoms | - | - | able to provoke | #4 |
gluten avoidance | decrease | non-celiac gluten sensitivity (NCGS) | patients with NCGS | for at least several weeks or months | treatment consists of | #5 |
reintroduction of increasing amounts of gluten | increase | gluten tolerance | patients with NCGS | - | allowing with time | #6 |
Several disorders related to the ingestion of gluten are well recognized despite overlapping clinical presentations: celiac disease, an autoimmune enteropathy triggered by gluten ingestions in susceptible individuals, allergy to wheat, and more recently non-celiac gluten sensitivity (NCGS). While celiac disease and wheat allergy are well-known disorders with a clear-cut diagnosis based on clinical tests and biological parameters, NCGS is a more difficult diagnosis, especially in children with functional gastrointestinal (GI) complaints. NCGS is considered a syndrome of intestinal but also extraintestinal symptoms occurring within hours, but sometimes even after several days of gluten ingestion. In children, the leading symptoms of NCGS are abdominal pain and diarrhea, while extraintestinal symptoms are rare, in contrast to adult patients. No precise diagnostic test nor specific biomarkers exist, except a rather cumbersome three-phase gluten-exposure, gluten-free diet, followed by a blinded placebo-controlled gluten challenge with crossover to provoke symptoms elicited by gluten in a reproducible manner that disappear on gluten-free alimentation. Recent data indicate that the peptide part of wheat proteins is not necessarily the sole trigger of clinical symptoms. Mono- or oligosaccharides, such as fructan and other constituents of wheat, were able to provoke GI symptoms in clinical trials. These new findings indicate that the term gluten sensitivity is probably too restrictive. The incidence of NCGS was reported in the range of 1-10% in the general population and to increase steadily; however, most data are based on patients' self-reported gluten intolerance or avoidance without a medically confirmed diagnosis. Treatment consists of gluten avoidance for at least several weeks or months. Patients with NCGS require regular reassessment for gluten tolerance allowing with time the reintroduction of increasing amounts of gluten.