Nonceliac gluten sensitivity or wheat intolerance syndrome?

T he increase in world-wide consumption of a Mediterranean diet, which includes a wide range of wheatbased foods, has possibly contributed to an alarming rise in the incidence of wheat (gluten?)-related disorders. Gluten, the main protein complex in wheat, barley, and rye, is a mixture of alcohol-insoluble (“glutenins”) and alcohol-soluble (“gliadins”) proteins. Gliadins are a group of proline and glutamine-rich proteins resistant to digestion in the gastrointestinal tract. Gluten consumption has been linked to a wide range of disorders, including celiac disease (CD), wheat allergy, dermatitis herpetiformis, gluten ataxia, peripheral neuropathy, and possibly a “new” entity called “nonceliac gluten sensitivity.” In fact, in recent years there has been a resurgent interest in an entity first described in 1978 a so-called “nonceliac gluten sensitivity” (NCGS). This concept now applies to patients who do not meet the criteria for CD, but who report experiencing a number of intestinal and/or extra-intestinal symptoms after consuming gluten-containing foods. These patients by definition present neither the autoantibodies nor the enteropathy characteristic of CD. We propose here that NCGS is a misnomer and probably an umbrella term including various clinical entities.