Non-celiac gluten sensitivity

Non-celiac gluten sensitivity (NCGS) is a syndrome characterized by intestinal and extraintestinal symptoms related to the ingestion of gluten-containing foods in patients not affected by celiac disease or gluten allergy. Symptoms occur within hours or days after the ingestion of gluten. Three gluten-induced heterogeneous situations were identified: a) celiac disease (autoimmune); b) allergy to wheat (allergic); c) non-celiac gluten sensitivity (non-autoimmune and non-allergic). Sensitivity to gluten has been described under various names: gluten hypersensitivity, gluten sensitivity, gluten intolerance, so that in 2012 the consensus established the name non-celiac gluten sensitivity (NCGS) to distinguish it from celiac disease. The incidence of NCGS in patients with neuropsychiatric symptoms - autistic spectrum disorders or schizophrenia - has been discussed in recent years, suggesting that they may be part of the NCGS spectrum in some cases. In general, NCGS, like celiac disease and wheat allergy, is treated with gluten-free diet. Since it is not known whether NCGS is permanent or transient, the periodic reintroduction of gluten into the diet may be recommended. Thus, celiac disease and gluten allergy are two well-defined gluten-induced diseases with clear diagnostic and treatment guidelines, while the NCGS is a controversial entity with more questions than answers upon pathogenesis, diagnosis and treatment.