Therefore, a subject sensitive to gluten manifests the typical symptoms of celiac disease even if it is not affected.
Non-celiac gluten sensitivity is also known as NCGS (from English Non-celiac gluten sensitivity).
, which affects genetically predisposed individuals of all age groups.In celiac patients, the ingestion of gluten-containing foods (containing gluten) triggers an immune response in the intestine, which damages the mucous membrane of the small intestine.
This damage results in the typical symptoms of celiac disease, which include abdominal pain, chronic diarrhea and / or constipation, growth retardation (in children), anemia and psychophysical fatigue.
Today we have several non-invasive tests available for the diagnosis of celiac disease, which allow us to evaluate the presence or absence of the typical autoimmune response to gluten; these tests are gradually replacing the test traditionally considered more reliable, that is the intestinal biopsy (through a "tube" introduced into the mouth and guided by a camera up to the small intestine, the doctor takes samples of intestinal mucosa). of celiac disease, therefore, the presence of strongly suggestive symptoms is NOT enough, but it is necessary, always and in any case, to demonstrate their existence through specific tests. This is a very important aspect, also because sometimes the symptoms of celiac disease are absent or manifest in an atypical way.
We can therefore have celiac subjects who do not manifest intestinal disorders. In non-celiac gluten sensitivity, on the other hand, exactly the opposite happens, that is, we have the presence of symptoms suggestive of celiac disease despite - following the tests just seen - it is possible to exclude the presence of the disease (no trace of "anti-gluten antibodies" and no traces of intestinal mucosal lesions).
Typically, gluten sensitivity is a less severe disorder than celiac disease.
to wheat proteins. The differences with respect to celiac disease reside in the type of antibodies involved (as well as in the severity of associated symptoms): while in celiac disease specific autoantibodies against tissue transglutaminase 2 (anti-TG2) are involved, in wheat allergy specific IgE antibodies are involved for some of its proteins.
As mentioned, there are also differences at the symptomatological level, given that wheat allergy is mainly characterized by disorders of the respiratory system (baker's asthma), sometimes with rather violent manifestations (anaphylaxis induced by physical exercise).
The diagnosis of wheat allergy mainly uses prick tests and specific RASTs.
;All these symptoms typically disappear with the elimination of gluten from the diet, only to reappear after its reintroduction, usually within hours or a few days.
- is a gastrointestinal disorder of functional origin (NOT pathological). In order to diagnose its presence, it is therefore necessary to first of all exclude any disease potentially responsible for the typical symptoms of IBS, which include chronic diarrhea and / or constipation, abdominal pain and cramps, bloating and flatulence.
Therefore, although the symptoms are similar, a person with IBS cannot be considered celiac, precisely because this condition must be excluded a priori even before we can speak of IBS.
The theories on the causes of irritable bowel syndrome are different and there is a certain consensus in considering it a multifactorial disorder; it means that different causes, of a genetic and environmental nature, would contribute to determining its onset. Among these there would also be the hypersensitivity to certain substances introduced with food, commonly responsible for food intolerances (gluten, lactose, salicylates, etc.).
The confirmation of this hypothesis derives from the fact that many people with IBS derive considerable benefits from an exclusion diet, that is, devoid of the substances mentioned above.
Based on these considerations, also confirmed by experimental evidence, it is plausible that a certain percentage of people with IBS (around 25-35%) are affected by non-celiac gluten sensitivity. This condition can be present in isolation or in a context of multiple intolerances.
of different nature and / or dysbiosis) and / or eating disorders. If something does not work perfectly in the digestion of food and / or in the absorption of the nutrients contained in them, the non-absorbed substances are fermented by the intestinal microbial flora, with the production of gas, fatty acids and other substances that can trigger the typical symptoms of IBS and NCGS. In case of too abundant and varied meals, intestinal disorders, chronic caloric surplus compared to the needs of the organism, the amount of nutrients not absorbed increases significantly, generating the symptoms listed above. At the same time, due to a loss of selectivity of the intestinal mucosa, there may also be an absorption of potentially sensitizing substances, which in normal conditions would be excreted with the faeces. All this to say that a subject considered sensitive to gluten could simply be a person who has been eating "too much and badly" for too long.
Molecular characterization studies, more and more numerous, are trying to identify markers of the disorder, which however are not always detectable. Preliminary evidence in this area seems to paint gluten sensitivity as a particular congenital immune reaction to gluten, naturally different from that which gives rise to celiac disease.
and that reappear following the reintroduction of gluten into the diet.It would also be preferable for such reintroduction to occur without the patient's knowledge, in order to rule out a possible placebo effect. in its entirety, from food combinations to any intolerances or hypersensitivity, from the intake of fiber to that of simple sugars, from the consumption of foods rich in additives to the intake of water. Equally important is the evaluation of certain psychological and behavioral elements, such as the level of physical activity, any stressors at family or work level and the possible intake of drugs, laxatives, alcohol and drugs.
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