What's the Best Way to Tell Celiac Disease from Non-Celiac Gluten Sensitivity?

Celiac.com 04/26/2021 - Doctors are still figuring the best way to tell celiac disease from non-celiac wheat or gluten sensitivity. A team of researchers recently assessed some key differences between celiac disease and non-celiac wheat or gluten sensitivity. 

The research team included A. Rej, I. Aziz, and D.S. Sanders. They are variously affiliated with the Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK; and the Department of Infection, Immunity and Cardiovascular Disease, Academic Unit of Gastroenterology, University of Sheffield, Sheffield, UK

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Celiac disease and non-celiac wheat or gluten sensitivity (NCWS/NCGS) are both common gluten‐related disorders, with similar presentations. Because both conditions can present with gastrointestinal and extra-intestinal manifestations, it can be difficult for doctors to tell them apart. 

Around 7% of individuals self‐reporting symptoms in relation to gluten ingestion have celiac disease. That's a significant number. For this reason, it is important that patients undergo a thorough workup to assess for the diagnosis, including celiac serology, as well as the exclusion of classic wheat allergy. 

Celiac disease is diagnosed by assessing serology and histology, but there are no clear biomarkers for the diagnosis of NCGS. Complicated celiac cases should be referred to a specialist, since even with recent developments in noninvasive celiac screening, histological assessment via duodenal biopsy remains the gold standard. 

Both conditions are treated with a gluten‐free diet, but the length and strictness of the gluten-free diet regime needed to properly treat NCGS is unclear. 

Following a GFD can be challenging for both celiacs and NCWS/NCGS sufferers, alike. 

While wheat/gluten is a known trigger for symptom generation in NCGS, it is unclear which components of wheat trigger symptoms in this group, and additional research required to understand the development of the condition.

Their paper on the subject, titled "Coeliac disease and non-coeliac wheat or gluten sensitivity," offers a detailed and comprehensive discussion of the two conditions. Read the full paper at the Journal of Internal Medicine (PAYWALL)