Gluten sensitivity without coeliac disease - a new twist

Gluten-containing products are often blamed for contributing to various gastrointestinal and extraintestinal symptoms. While coeliac disease is a well-established entity, our understanding of non-coeliac gluten sensitivity (NCGS) is limited. Issues confounding progress in NCGS include the limited recognition of dietary components that often co-exist with gluten that might be triggering symptoms, lack of understanding of the mechanisms by which gluten might induce problems, and problems with clinical trial design and subsequent interpretation of results. A recent controlled trial using gold-standard elimination-rechallenge methodology in patients with self-reported NCGS has failed to confirm a gluten-specific effect on gastrointestinal symptoms. Furthermore, mechanisms by which gluten triggers symptoms remain unidentified. It is suggested that patients with suspected NCGS should explore other dietary triggers before exploring the gluten-free diet as an option.