2015-09-08 17:11:35 UTC

5 Things to Know About Non-Celiac Gluten Sensitivity

Sept. 8, 2015

In a recent CGH editorial, Drs. Benjamin Lebwohl and Daniel A. Leffler explore the strange new world of non-celiac gluten sensitivity.

This month’s issue of Clinical Gastroenterology and Hepatology features the latest clinical trial investigating the phenomenon of non-celiac gluten sensitivity. An editorial on this study, by Benjamin Lebwohl, MD, and Daniel A. Leffler, MD, MS, explains that this trial, like its predecessors, seems only to contribute to the uncertainty about non-celiac gluten sensitivity.

While additional research is needed to understand this evolving entity, Drs. Lebwohl and Leffler offer five things the current literature base tells us about non-celiac gluten sensitivity.

1. Non-celiac gluten sensitivity is distinct from IBS in that extraintestinal symptoms are prominent and respond to dietary modification, unlike the extraintestinal symptoms that can be seen in IBS.

2. There are no proven biomarkers for non-celiac gluten sensitivity at this time, and studies focused on these have had, at best, conflicting results. This is particularly important to emphasize in light of the fact that patients are looking for answers and may be offered testing for non-celiac gluten sensitivity via non-evidence-based tests of blood, stool or saliva.

3. In the current CGH study, it is undeniable that gluten exerts a large nocebo effect on a significant number of patients, which is consistent with that observed in previous trials. This needs to be accounted for in the design of future trials and acknowledged in our discussions with patients who are coming to us seeking an honest, evidence-based approach to improving their health.

4. The great utility of blind gluten challenges has led to overly ambitious studies. If nothing else, non-celiac gluten sensitivity is a complex entity and will not give up its secrets easily. As such, studies with more limited but focused aims are likely to be more effective in providing important incremental knowledge.

5. It is counterproductive to debate whether non-celiac gluten sensitivity is “real”; the patients are real and seeking our care. Some of these patients are in a great deal of distress and we should try to help them. At the present time, this involves ruling out celiac disease, testing for additional food intolerances or gastrointestinal conditions, and providing the latest data regarding what we know — and what we do not know — about this evolving entity.

Read the latest research and editorial on non-celiac gluten sensitivity from the September issue of Clinical Gastroenterology and Hepatology.

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