Non-celiac gluten/wheat sensitivity (NCGS) - a currently undefined disorder without validated diagnostic criteria and of unknown prevalence

Reese I, Schaefer C, Kleine-Tebbe J, Ahrens B, Bachmann O, Ballmer-Weber B, Beyer K, Bischoff SC, Blumchen K, Doelle S, Enck P, Enninger A, Huttegger , Laemmel S, Lange L, Lepp U, Mahler V, Moennikes H, Ockenga J, Otto B, Schnadt S, Szepfalusi Z, Treudler R, Wassmann-Otto A, Zuberbier T, Werfel T, Worm M (2019)

Publication Type: Journal article

Publication year: 2019

Journal

Book Volume: 42

Pages Range: 111-117

Journal Issue: 3

DOI: 10.5414/ALX02060

Abstract

Within the last decade, non-celiac gluten/ wheat sensitivity (NCGS) has been increasingly discussed not only in the media but also among medical specialties. The existence and the possible triggers of NCGS are controversial. Three international expert meetings which proposed recommendations for NCGS were not independently organized and only partially transparent regarding potential conflicts of interest of the participants. The present position statement reflects the following aspects about NCGS from an allergist's and nutritionist's point of view: (A) Validated diagnostic criteria and/or reliable biomarkers are still required. Currently, this condition is frequently self-diagnosed, of unknown prevalence and non-validated etiology. (B) Gluten has not been reliably identified as an elicitor of NCGS because of high nocebo and placebo effects. Double-blind, placebo-controlled provocation tests are of limited value for the diagnosis of NCGS and should be performed in a modified manner (changed relation of placebo and active substance). (C) Several confounders hamper the assessment of subjective symptoms during gluten-reduced or gluten-free diets. Depending on the selection of food items, e.g., an increased vegetable intake with soluble fibers, diets may induce physiological digestive effects and can modify gastrointestinal transit times independent from the avoidance of gluten. (D) A gluten-free diet is mandatory in celiac disease based on scientific evidence. However, a medically unjustified avoidance of gluten may bear potential disadvantages and risks. (E) Due to a lack of diagnostic criteria, a thorough differential diagnostic work-up is recommended when NCGS is suspected. This includes a careful patient history together with a food-intake and symptom diary, if necessary an allergy diagnostic workup and a reliable exclusion of celiac disease. We recommend such a structured procedure since a medically proven diagnosis is required before considering the avoidance of gluten

Authors with CRIS profile

Involved external institutions

Universitätsspital Zürich (USZ) Switzerland (CH) Universität Hohenheim Germany (DE) Charité - Universitätsmedizin Berlin Germany (DE) Universität Leipzig Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Karl-Olga-Krankenhaus Germany (DE) Martin-Luther-Krankenhaus Germany (DE) Deutscher Allergie- und Asthmabund e.V. Germany (DE) Universitätsklinikum Frankfurt am Main (KGU) Germany (DE) Universitätsklinikum Tübingen Germany (DE) Klinikum St. Marien Amberg Germany (DE) Medizinische Universität Wien Austria (AT) Paracelsus Medizinische Privatuniversität, Nürnberg Germany (DE) Klinikum der Universität München Germany (DE) Paul Ehrlich Institute / Paul-Ehrlich-Institut – Bundesinstitut für Impfstoffe und biomedizinische Arzneimittel (PEI) Germany (DE) Klinikverbund Bremen (Gesundheit Nord) Germany (DE) Allergie- und Asthma-Zentrum Westend (AAZW) Germany (DE)

How to cite

APA:

Reese, I., Schaefer, C., Kleine-Tebbe, J., Ahrens, B., Bachmann, O., Ballmer-Weber, B.,... Worm, M. (2019). Non-celiac gluten/wheat sensitivity (NCGS) - a currently undefined disorder without validated diagnostic criteria and of unknown prevalence. Allergologie, 42(3), 111-117. https://dx.doi.org/10.5414/ALX02060

MLA:

Reese, I., et al. "Non-celiac gluten/wheat sensitivity (NCGS) - a currently undefined disorder without validated diagnostic criteria and of unknown prevalence." Allergologie 42.3 (2019): 111-117.

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