The gluten challenge
Gluten is the main structural protein complex of wheat and is found in other cereals such as barley and rye. For some people, exposure to gluten protein fragments called gliadins causes an immune-mediated reaction that may lead to the development of bloating, abdominal pain, diarrhoea, and muscle, bone or joint pain. The most well-known condition associated with gluten intolerance is coeliac disease, which is thought to affect around 1% of the general population1 and is often associated with weight loss due to intestinal damage and nutrient malabsorption.
According to Prof. Mulder, a coeliac disease expert and Head of the Department of Gastroenterology and Hepatology at VU Medical Center in Amsterdam, The Netherlands, a life-long gluten-free diet is currently the only treatment available for people with this condition. “In symptomatic patients with coeliac disease, there is a clear benefit to eating a gluten-free diet,” he says. “Besides relieving the symptoms, a gluten-free diet is likely to reduce long-term complications such as osteoporosis, refractory coeliac disease and small bowel malignancies.”
The emergence of NCGS
The possibility of NCGS was first raised in the late 1980s; however, significant scientific interest has only emerged in recent years after it became apparent that some individuals have gluten sensitivity without the typical histological, serological or clinical signs of coeliac disease.2–4 Although attempts have now been made to define NCGS,1 the typical symptoms of the condition are similar to those of coeliac disease, making it difficult to identify the condition in clinical practice.
“Coeliac centres struggle to define this syndrome,” Prof. Mulder says. “Currently, we can only identify NCGS in patients with intestinal and other typical coeliac symptoms after they have responded to a gluten-free diet but had coeliac disease ruled out during a proper diagnostic work-up. We need better criteria for NCGS for use in our day-to-day clinical practice.”
Gluten-free bonanza – but at what cost?
In the past, a gluten-free diet was a specialist diet reserved only for people with coeliac disease and other gluten-related autoimmune disorders. Today, the gluten-free business is booming, and Prof. Mulder believes that commercially-driven information about NCGS may lead to an increasing number of people turning unnecessarily to a gluten-free diet.
“Since NCGS appeared in the scientific arena, there is gluten-free business everywhere – especially in Australia and New Zealand, where gluten-free food is readily available in restaurants and stores,” he explains. “As anyone with coeliac disease will tell you, adherence to a gluten-free diet can be stressful, expensive and very difficult, so we must be wary of advocating a gluten-free diet to any other groups of patients at this point in time. In the case of NCGS, we simply don’t know enough about it yet for us to recommend any specific management approach, including a gluten-free diet.”
- Sapone A et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Medicine 2012;10:13.
- Di Sabatino A, Corazza GR. Nonceliac gluten sensitivity: sense or sensibility? Ann Intern Med 2012;156(4):309–11.
- Troncone R, Jabri B. Coeliac disease and gluten sensitivity. J Intern Med 2011;269(6):582–90.
- Biesiekierski JR et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol 2011;106(3):508–14.
Notes to Editors
UEG, or United European Gastroenterology, is a professional non-profit organisation combining all the leading European societies concerned with digestive diseases. Together, its member societies represent over 22,000 specialists, working across medicine, surgery, paediatrics, gastrointestinal oncology and endoscopy. This makes UEG the most comprehensive organisation of its kind in the world, and a unique platform for collaboration and the exchange of knowledge.
To advance standards of gastroenterological care and knowledge across Europe and the world, UEG offers numerous activities and initiatives, including:
- UEG Week, the biggest congress of its kind in Europe, and one of the two largest in the world
- Courses, covering the latest science and clinical information in the field, including diagnosis, treatment and real-life examples
- UEG e-learning, an ever-expanding archive of over 11,000 documents and more than 1,000 multimedia items, as well as accredited e-courses
- Training Support, funding for innovative training and educational programmes, as well as international scientific and professional co-operations
- UEG Journal, published bi-monthly, covering translational and clinical studies from all areas of gastroenterology
- EU Affairs, promoting research, prevention, early diagnosis and treatment of digestive diseases, and helping develop an effective health policy for Europe
Find out more about UEG’s work. Visit www.ueg.eu
NVGE - Dutch Association of Gastroenterology – www.nvge.nl