Gluten Sensitivity

Gluten sensitivity (also gluten intolerance) is a spectrum of disorders, including celiac disease and wheat allergy, in which gluten has an adverse effect on the body. Idiopathic gluten sensitivity can be defined as a non-allergic and non-autoimmune condition in which the consumption of gluten can lead to symptoms similar to those observed in celiac disease or wheat allergy (other conditions which fall under the gluten-related disorders spectrum).

Symptoms of gluten sensitivity include bloating, abdominal discomfort or pain, and diarrhea, and might present extraintestinal symptoms including muscular disturbances and bone or joint pain. There may be a lack of clear symptoms of chronic preceding diseases such as gluten-sensitive enteritis associated T-cell lymphoma (referred to as de novo EATL).

Until recently, the terms gluten sensitivity and celiac disease were used interchangeably in medical literature. However, emerging research indicates that gluten sensitivity has a broader scope than celiac disease. If the medical history of a patient, along with clinical tests, rule out celiac disease and wheat allergy, a diagnosis of idiopathic gluten sensitivity can be considered. However, certain criteria need to be met before a diagnosis of gluten sensitivity can be confirmed (see diagnosis section). Treatment for all three conditions is a gluten-free diet, the difference being that with wheat allergy the interruption is temporary and drugs may be administered, whereas in the case of celiac disease the diet is lifelong and even ingesting very small amounts of gluten-containing food could damage the patient's health. In other cases, such as refractory celiac disease or EATL, withdrawal of gluten without other treatment may be ineffectual.

Gluten is a protein composite found in wheat and other grains, including barley, corn, rice, oats, rye and processed foods thereof. Gluten is composed of a gliadin fraction (alcohol soluble) and a glutenin fraction (only soluble in dilute acids or alkali). Gluten gives elasticity to dough helping it to rise and to keep its shape. It is found in many staple foods in the Western diet.