Published online Oct 28, 2017. doi: 10.3748/wjg.v23.i40.7201
Peer-review started: June 7, 2017
First decision: July 27, 2017
Revised: August 14, 2017
Accepted: September 5, 2017
Article in press: September 5, 2017
Published online: October 28, 2017
Currently, 1% of the United States population holds a diagnosis for celiac disease (CD), however, a more recently recognized and possibly related condition, “non-celiac gluten sensitivity” (NCGS) has been suggested to affect up to 6% of the United States public. While reliable clinical tests for CD exist, diagnosing individuals affected by NCGS is still complicated by the lack of reliable biomarkers and reliance upon a broad set of intestinal and extra intestinal symptoms possibly provoked by gluten. NCGS has been proposed to exhibit an innate immune response activated by gluten and several other wheat proteins. At present, an enormous food industry has developed to supply gluten-free products (GFP) with GFP sales in 2014 approaching $1 billion, with estimations projecting sales to reach $2 billion in the year 2020. The enormous demand for GFP also reflects a popular misconception among consumers that gluten avoidance is part of a healthy lifestyle choice. Features of NCGS and other gluten related disorders (e.g., irritable bowel syndrome) call for a review of current distinctive diagnostic criteria that distinguish each, and identification of biomarkers selective or specific for NCGS. The aim of this paper is to review our current understanding of NCGS, highlighting the remaining challenges and questions which may improve its diagnosis and treatment.
Core tip: Non-celiac gluten sensitivity, a less known clinical entity has been estimated to have a prevalence of up to 6% in the United States. This review identifies the pathophysiology of the disease delineating clearly the important components of wheat which play a role in its innate immune response. The updated guidelines on the diagnosis of this disease is discussed here with a bridge to other management strategies apart from the gluten free diet that are now being investigated.