Celiac Disease and Non-Celiac Gluten Sensitivity - Abstract
Wheat has been a staple in the human diet for over 10,000 years. However, in contrast to ruminant animals, humans did not evolve to digest wheat gluten completely before it leaves our one-chambered stomach. Response to the dietary proteins in wheat can result in a variety of symptoms and immunologic responses. In celiac disease, genetically predisposed
patients react to the gliadin fraction of wheat gluten, and this result in a variety of intestinal and extra-intestinal manifestations. In contrast, wheat allergy is typically an IgE mediated response, resulting in gastrointestinal, skin and/or respiratory symptomatology. Non-celiac gluten sensitivity is a relatively new entity, and has an evolving definition. It is thought to occur when patients who have neither celiac disease nor wheat allergy exhibit symptom improvement upon dietary gluten withdrawal. Conditions in this category include dermatitis herpetiformis, irritable bowel syndrome, autism and gluten-sensitive ataxia. All of these entities respond to a gluten-free diet, but is it important for patients and health care practitioners to understand the distinctions. The potential health implications of differentiating among an “autoimmune” disorder, “allergy” and “sensitivity” are broad. Significant morbidity can result if the specific condition is not identified and treated correctly.