Published online Jun 21, 2015. doi: 10.3748/wjg.v21.i23.7110
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
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.
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.