Celiac Disease and Non-Celiac Gluten Sensitivity; Evidences and Differences

There are too many papers published regarding the definition, diagnosis and treatment of celiac disease (CD). All we know that CD is a major health care issue affecting people in any ages, and increased wheat consumption may have had an effect on CD prevalence, which was reported worldwide prevalence of approximately 1% [1]. Most of the celiac patients report long gastrointestinal symptoms such as abdominal pain, tenderness, or irregular bowel habits like constipation or diarrhea or alternating bowel movements. Very often they consult a number of physicians, seeking to reach a CD diagnosis but they are considered to be simply suffering from irritable bowel syndrome (IBS) [2]. According to ACG clinical guidelines, in individuals over the age of 2 years, anti-tissue transglutaminase (TTG) immunoglobulin A (IgA) antibody is strongly recommended and preferred for celiac disease diagnosis. But in children younger than 2 years, the IgA TTG test should be used combined with DGP (IgA and IgG) [3]. Currently, the only safe and effective treatment is a strict gluten-free diet (GFD) accompany with nutritional support, which improves the health and quality of life in the vast majority of patients [4]. There is no doubt that GFD so effective in symptomatic CD patients, and reduce the risk of malignancies such as osteoporosis, refractory CD and small intestinal lymphoma [5]. On the other hands, a consistent percentage of the general population consider themselves to be suffering from troubles caused by wheat and/or gluten ingestion, even if they do not have celiac disease or wheat allergy (WA), as they test negative both for CD serology and histopathology and for IgE-mediated assays. Most patients report both gastrointestinal and non-gastrointestinal symptoms, all agreeing, however, about the reduction of symptoms on a gluten-free diet. This clinical condition has been recently named Non-Celiac Gluten Sensitivity (NCGS) [6]. We talk about NCGS when CD serology, duodenal histology and IgE-based assays are negative (Table 1).