Until relatively recently, the most well-known medical condition associated with gluten sensitivity was celiac disease. This is caused by an immune response to the cereal protein gluten in susceptible people. Celiac disease is a potentially serious condition that can cause intestinal symptoms such as weight loss and chronic diarrhea and other health problems including anemia, osteoporosis, joint pain, dermatitis and neurological symptoms. The condition affects around 1% of the general population and is diagnosed using a combination of a blood test for antibodies and a biopsy of the small intestine. A life-long gluten-free diet is currently the only treatment available.
It is now widely accepted that gluten sensitivity can also occur in people without celiac disease. Non-celiac gluten sensitivity (NCGS), as it is known, is associated with a similar range of acute symptoms to celiac disease, making it difficult to differentiate between the two conditions based on symptoms alone. NCGS is diagnosed by a process of exclusion and currently there is no biomarker to detect it. It seems likely that NCGS is far more prevalent than celiac disease, with a recent UK study2 suggesting that, out of every 100 patients with gluten sensitivity referred for specialist investigation, 10 will be diagnosed with celiac disease and 90 will have NCGS.
“In this study, 13% of adults screened in the general population said they had gluten sensitivity, which is a significant number of people,” said Prof. Sanders. “We were very interested to find that the vast majority of individuals referred to secondary care with gluten sensitivity were diagnosed with NCGS and that these people were far less likely to have nutritional deficiencies or autoimmune disorders than the patients diagnosed with coeliac disease.”
Prof. Sanders thinks the best way for doctors to approach patients who present with symptoms relating to eating gluten is to focus on excluding celiac disease using blood tests and, where necessary, gastroscopy with a biopsy of the small bowel. However, he says, physicians need to make sure patients are eating a normal diet at the time of diagnosis. “Any patient who presents saying they have gluten-related symptoms is likely to have placed themselves on a gluten-free diet,” he says. “It is essential that these patients stop their gluten-free diet and eat a normal diet in order for us to exclude celiac disease.”