Advances in Celiac Disease
Advances in Celiac Disease
Self-initiated treatment with gluten-free diet is increasingly common. The market of gluten-free food is disproportionate with the number of diagnosed and undetected coeliac disease patients, and increases annually by 25% in most Western countries. Many of the gluten-free food consumers suffer from noncoeliac gluten sensitivity which is an entity with clinical signs suggestive of coeliac disease, but without the typical enteropathy or serology. There are no specific tests for the condition, although a basophil activation test has been suggested to be of use. Elevated levels of antigluten IgG suggests immune activation, but is not diagnostic. Data on mucosal immunopathology show conflicting results. A large retrospective study found that the condition does not have the HLA associations of coeliac disease. The study also showed that many patients presented with symptoms compatible with IBS, although this was not specifically noted. Few patients were diagnosed with coeliac disease. A controlled trial of gluten in IBS patients suggested modest gluten-related symptoms. Two studies from Australia deserve particular attention. The first study reported that in IBS patients on a gluten-free diet, a re-introduction of gluten in a double-blinded manner could induce symptoms. The second study from the same group, using a more sophisticated cross-over protocol, could not find any signs of gluten-induced symptoms. Thus, the authors questioned the existence of noncoeliac gluten sensitivity.
Albeit often poorly defined, associations between gluten consumption and a range of disorders have been reported. Gluten has been implicated in autism – a notion that received support from the findings of elevated levels of antigluten IgG in autistic children. Dietary intervention was not studied.
Noncoeliac Gluten Sensitivity
Self-initiated treatment with gluten-free diet is increasingly common. The market of gluten-free food is disproportionate with the number of diagnosed and undetected coeliac disease patients, and increases annually by 25% in most Western countries. Many of the gluten-free food consumers suffer from noncoeliac gluten sensitivity which is an entity with clinical signs suggestive of coeliac disease, but without the typical enteropathy or serology. There are no specific tests for the condition, although a basophil activation test has been suggested to be of use. Elevated levels of antigluten IgG suggests immune activation, but is not diagnostic. Data on mucosal immunopathology show conflicting results. A large retrospective study found that the condition does not have the HLA associations of coeliac disease. The study also showed that many patients presented with symptoms compatible with IBS, although this was not specifically noted. Few patients were diagnosed with coeliac disease. A controlled trial of gluten in IBS patients suggested modest gluten-related symptoms. Two studies from Australia deserve particular attention. The first study reported that in IBS patients on a gluten-free diet, a re-introduction of gluten in a double-blinded manner could induce symptoms. The second study from the same group, using a more sophisticated cross-over protocol, could not find any signs of gluten-induced symptoms. Thus, the authors questioned the existence of noncoeliac gluten sensitivity.
Albeit often poorly defined, associations between gluten consumption and a range of disorders have been reported. Gluten has been implicated in autism – a notion that received support from the findings of elevated levels of antigluten IgG in autistic children. Dietary intervention was not studied.
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