Non-Celiac Gluten Sensitivity: The New Frontier of Gluten Related Disorders

Nyeste oppdateringen på gluten, som nevner at det ikke er glutenet i korn som er det største problemet, men FODMAPs. Ikke-cøliakisk glutenintoleranse er reell for noen, men ikke så mange som vi trodde. FODMAPs gjelder flere. Nevner også at dette kan gjelde opptil 30% av befolkningen. Beskriver symptomer på glutenintoleranse, og at pasienten ofte har oppdaget et fobindelse selv med sine symptomer når de kutter gluten-korn.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820047/

Non Celiac Gluten sensitivity (NCGS) was originally described in the 1980s and recently a “re-discovered” disorder characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food, in subjects that are not affected with either celiac disease (CD) or wheat allergy (WA). Although NCGS frequency is still unclear, epidemiological data have been generated that can help establishing the magnitude of the problem. Clinical studies further defined the identity of NCGS and its implications in human disease. An overlap between the irritable bowel syndrome (IBS) and NCGS has been detected, requiring even more stringent diagnostic criteria. Several studies suggested a relationship between NCGS and neuropsychiatric disorders, particularly autism and schizophrenia. The first case reports of NCGS in children have been described. Lack of biomarkers is still a major limitation of clinical studies, making it difficult to differentiate NCGS from other gluten related disorders. Recent studies raised the possibility that, beside gluten, wheat amylase-trypsin inhibitors and low-fermentable, poorly-absorbed, short-chain carbohydrates can contribute to symptoms (at least those related to IBS) experienced by NCGS patients. In this paper we report the major advances and current trends on NCGS.

In order to develop a consensus on new nomenclature and classification of gluten-related disorders, a panel of experts first met in London, in February 2011. The panel proposed a series of definitions and developed a diagnostic algorithm that has been recently published [4].

After the 2011 London Meeting, many new papers have been published on GS. Although its frequency in the general population is still unclear, epidemiological data have been generated that can help establish the magnitude of the problem. Clinical studies further defined the identity of GS and its possible implications in human disease. An overlap between the irritable bowel syndrome (IBS) and GS has been suspected, requiring even more stringent diagnostic criteria. The first case reports of GS in children have been described. Lack of biomarkers is still a major limitation of clinical studies, making the differential diagnosis with other gluten related disorders, as well conditions independent to gluten exposure, difficult.

Evaluation and discussion of this new information was the aim of a Second Expert Meeting on GS that was held in Munich, November 30–December 2, 2012. In this paper we report the major advances and current trends on GS, as presented and debated at the Munich meeting.

According to recent population-based surveys performed in Northern Europe, the prevalence of IBS in the general adult population is 16%–25% [11,12]. In a selected (and, therefore, probably biased) series of adults with IBS, the frequency of NCGS, documented by a double-blind, placebo-controlled challenge, was 28% [13]. In the large study performed by Carroccio et al., 276 out of 920 (30%) subjects with IBS-like symptoms, according to the Rome II criteria, suffered from wheat sensitivity or multiple food hypersensitivity, including wheat sensitivity [14]. Should a consistent proportion of IBS patients be affected with NCGS, the prevalence of NCGS in the general population could well be higher than CD (1%).

NCGS is characterized by symptoms that usually occur soon after gluten ingestion, disappear with gluten withdrawal and relapse following gluten challenge, within hours or few days. The “classical” presentation of NCGS is a combination of IBS-like symptoms, including abdominal pain, bloating, bowel habit abnormalities (either diarrhea or constipation), and systemic manifestations such as “foggy mind”, headache, fatigue, joint and muscle pain, leg or arm numbness, dermatitis (eczema or skin rash), depression, and anemia [2,15]. When seen at the specialty clinic, many NCGS patients already report the causal relationship between the ingestion of gluten-containing food and worsening of symptoms. In children, NCGS manifests with typical gastrointestinal symptoms, such as abdominal pain and chronic diarrhea, while the extra-intestinal manifestations seem to be less frequent, the most common extra-intestinal symptom being tiredness [16].

In a second study, Biesiekirski et al. reported on 37 patients with IBS/self-reported NCGS investigated by a double-blind crossover trial. Patients were randomly assigned to a period of reduced low-fermentable, poorly-absorbed, short-chain carbohydrates (fermentable oligo-, di-, and mono-saccharides and polyols = FODMAPs) diet and then placed on either a gluten or whey proteins challenge. In all participants, gastrointestinal complaints consistently improved during reduced FODMAP intake, but significantly worsened to a similar degree when their diets included gluten or whey proteins [21].FODMAPS list includes fructans, galactans, fructose, and polyols that are contained in several foodstuffs, including wheat, vegetables, and milk derivatives. These results raise the possibility that the positive effect of the GFD in patients with IBS is an unspecific consequence of reducing FODMAPs intake, given that wheat is one of the possible sources of FODMAPs.

The pathophysiology of NCGS is under scrutiny. In the study conducted by Sapone et al. [2], NCGS subjects showed a normal intestinal permeability and claudin-1 and ZO-1 expression compared with celiac patients, and a significantly higher expression of claudin-4.

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