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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2015; 21(23): 7110-7119
Published online Jun 21, 2015. doi: 10.3748/wjg.v21.i23.7110
Diagnosis of gluten related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity
Luca Elli, Federica Branchi, Carolina Tomba, Danilo Villalta, Lorenzo Norsa, Francesca Ferretti, Leda Roncoroni, Maria Teresa Bardella
Luca Elli, Federica Branchi, Carolina Tomba, Lorenzo Norsa, Francesca Ferretti, Leda Roncoroni, Maria Teresa Bardella, Center for the Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
Luca Elli, Federica Branchi, Carolina Tomba, Lorenzo Norsa, Francesca Ferretti, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
Danilo Villalta, Allergology and Clinical Immunology Unit, AO «Santa Maria degli Angeli, 33170 Pordenone, Italy
Leda Roncoroni, Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy
Author contributions: Elli L, Branchi F and Tomba C contributed equally to this work and wrote the manuscript; Ferretti F contributed to the writing of the manuscript and collected bibliography; Norsa L wrote the pediatric paragraph and Villalta D wrote the paragraph on allergy; Roncoroni L elaborated the paragraphs on gluten and gluten-free diet; Bardella MT developed the editorial scope and wrote the manuscript.
Conflict-of-interest: Luca Elli has received fees as board member of Dr Schaer Institute. Other authors have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Luca Elli, MD, PhD, Center for the Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy. dottorlucaelli@gmail.com
Telephone: +39-2-55033384 Fax: +33-2-55033644
Received: January 29, 2015
Peer-review started: January 29, 2015
First decision: March 26, 2015
Revised: April 3, 2015
Accepted: May 4, 2015
Article in press: May 4, 2015
Published online: June 21, 2015
Abstract

Cereal crops and cereal consumption have had a vital role in Mankind’s history. In the recent years gluten ingestion has been linked with a range of clinical disorders. Gluten-related disorders have gradually emerged as an epidemiologically relevant phenomenon with an estimated global prevalence around 5%. Celiac disease, wheat allergy and non-celiac gluten sensitivity represent different gluten-related disorders. Similar clinical manifestations can be observed in these disorders, yet there are peculiar pathogenetic pathways involved in their development. Celiac disease and wheat allergy have been extensively studied, while non-celiac gluten sensitivity is a relatively novel clinical entity, believed to be closely related to other gastrointestinal functional syndromes. The diagnosis of celiac disease and wheat allergy is based on a combination of findings from the patient’s clinical history and specific tests, including serology and duodenal biopsies in case of celiac disease, or laboratory and functional assays for wheat allergy. On the other hand, non-celiac gluten sensitivity is still mainly a diagnosis of exclusion, in the absence of clear-cut diagnostic criteria. A multimodal pragmatic approach combining findings from the clinical history, symptoms, serological and histological tests is required in order to reach an accurate diagnosis. A thorough knowledge of the differences and overlap in clinical presentation among gluten-related disorders, and between them and other gastrointestinal disorders, will help clinicians in the process of differential diagnosis.

Keywords: Celiac disease, Gluten sensitivity, Wheat sensitivity, Allergy, Gluten-free diet

Core tip: Gluten-related disorders (celiac disease, wheat allergy and non-celiac gluten sensitivity) have emerged as an epidemiologically relevant phenomenon with an estimated global prevalence close to 5%. Although they are characterised by peculiar pathogenetic pathways involved in their development, they share similar clinical manifestations making their differential diagnosis challenging. A multimodal pragmatic approach combining findings from the patient’s clinical history, symptoms, serological and histological tests, as described in the present manuscript, is required for an accurate diagnosis.