There are questions in the literature, at Dr’s Surgeries, in hospitals and in clinics relating to the existence of gluten generated problems including, increased gut permeability and gastrointestinal symptoms in patients that do not diagnostically qualify as being coeliac.
In fact many people will state they are aware that not eating gluten helps them, and aids well -being , and may even resolve quite significant physical distress. They note recovery on a GFD and yet still have problems achieving medical and family support for their activities.
This recent review paper from the journal of Gastroenterology and Hepatology brings some clarity to this subject and will I hope begin to build some substance in the literature for a commonly found problem.[1]
Conclusions: Non-coeliac gluten intolerance does exist. Future studies need to identify issues of the dose of gluten needed and mechanisms of action.
The traditional definition of coeliac disease is inadequate because it includes only patients with abnormal small intestinal morphology. Gluten sensitivity is a systemic disorder whose common factor is an immune response to gluten in the context of the susceptible ‘coeliac’ HLA haplotype and possibly environmental triggers.
Gluten sensitivity also embraces traditional coeliac disease as well as subjects with normal small bowel morphology including latent coeliac disease, dermatitis herpetiformis, and symptomatic gluten intolerance. The diagnosis of gluten sensitivity and coeliac disease are not mutually inclusive. Small intestinal biopsy and clinical criteria are essential in diagnosing classical coeliac disease. IgA endomysial antibody is valuable in identifying gluten sensitivity and has particular value as a screening test. Serology should include total IgA levels to exclude selective IgA deficiency, a potential cause of false negative IgA endomysial antibody. A combination of histology, serology and clinical criteria will identify most cases of coeliac disease and gluten sensitivity.[2]
Comment
Gluten Free Diets are very hard to comply with 100% as its ubiquitous occurrence means that even unsuspected foods and food stuffs are often made with wheat or other gluten containing grains. In addition a single transgression can impact upon physical barrier integrity leading to increased gut permeability and risk of linked immune responses.[3] In order to enhance the benefits linked to GFD diet additional supplementation to aid immune health and barrier integrity may well be the route best explored.
References
[1] Newnham ED. Does gluten cause gastrointestinal symptoms in subjects without coeliac disease? J Gastroenterol Hepatol. 2011 Apr;26 Suppl 3:132-4. doi: 10.1111/j.1440-1746.2011.06653.x View Abstract
[2] Loft DE, Nwokolo CU, Ciclitira PJ. The diagnosis of gluten sensitivity and coeliac disease–the two are not mutually inclusive. Eur J Gastroenterol Hepatol. 1998 Nov;10(11):911-3. View Abstract
[3] Hamilton I, Cobden I, Rothwell J, Axon AT. Intestinal permeability in coeliac disease: the response to gluten withdrawal and single-dose gluten challenge. Gut. 1982 Mar;23(3):202-10. View Abstract
