1
|
Akman S, Şahaloğlu Ö, Dalkan C, Bahçeciler NN, Arıkan Ç. Is celiac disease misdiagnosed in children with functional constipation? TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 29:210-214. [PMID: 29749329 DOI: 10.5152/tjg.2018.17369] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND/AIMS Functional constipation is one of the common problems in childhood, and it comprises approximately 5% of the pediatric outpatient clinical applications. On the other hand, celiac disease (CD) is an immune enteropathy with the prevalence between 1/150 and 1/200. In addition to the classical symptoms of the disease such as diarrhea and weight loss, the incidence of atypical symptoms is increasing. This study aims to determine the prevalence of CD in patients with chronic constipation. MATERIALS AND METHODS The study was conducted between 2010 and 2012 and included 1046 children (range, 2-18 y; median, 11.4 y) diagnosed with chronic constipation according to the Rome III criteria. Serum immunoglobulin A, tissue transglutaminase, and/or anti-endomysial antibodies were examined. The patients with serological positive results were subjected to upper gastrointestinal system endoscopy and duodenal biopsy to confirm the diagnosis of CD. RESULTS Blood tests were positive in 36 patients (3.25%). One of the patients had Hashimoto's thyroiditis, and 4 patients had short stature. Endoscopic findings included nodularity in bulbus and duodenal mucosa (n=16), scalloping fold (n=13), and normal mucosa (n=5). Histopathologic findings revealed that 10 patients had total villous atrophy, 24 patients had subtotal and partial villous atrophy, and 34 patients had intraepithelial lymphocyte infiltration. All patients followed a gluten-free diet, resulting in a resolution of symptoms. CONCLUSION In the present study, a CD ratio of 1:28 was diagnosed in chronically constipated children. The use of screening tests for CD should be considered in children with conventional treatment-resistant constipation.
Collapse
Affiliation(s)
- Sezin Akman
- Department of Pediatrics, Balıkesir University School of Medicine, Balıkesir, Turkey
| | - Özlem Şahaloğlu
- Department of Pediatrics, Near East University School of Medicine, Cyprus
| | - Ceyhun Dalkan
- Department of Pediatrics, Near East University School of Medicine, Cyprus
| | | | - Çiğdem Arıkan
- Department of Pediatrics, Near East University School of Medicine, Cyprus
| |
Collapse
|
2
|
Differentiating Between Lactose Intolerance, Celiac Disease, and Irritable Bowel Syndrome-Diarrhea. J Nurse Pract 2017. [DOI: 10.1016/j.nurpra.2017.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
3
|
Mohammadibakhsh R, Sohrabi R, Salemi M, Mirghaed MT, Behzadifar M. Celiac disease in Iran: a systematic review and meta-analysis. Electron Physician 2017; 9:3883-3895. [PMID: 28461861 PMCID: PMC5407219 DOI: 10.19082/3883] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 01/21/2017] [Indexed: 01/13/2023] Open
Abstract
Introduction Celiac disease (CD) is a chronic autoimmune-mediated disorder with both intestinal and systemic manifestations. The aim of this study was to determine the prevalence of celiac disease in Iran. Methods We conducted a systematic search on Embase, Pub Med, Web of Science, Google Scholar, MagIran, Scientific Information database (SID) and Iranmedex from 2003 through to November 2015. The Der-Simonian/Laird’s (DL), with a 95% confidence interval employed to estimate the overall pooled prevalence. Heterogeneity was investigated by using subgroup analysis based on sample size and time of study. Results Sixty-three studies with 36,833 participants met inclusion criteria for analysis. The overall prevalence of celiac disease in 63 studies that had used serological tests for the diagnosis was observed as 3% (95% CI: 0.03–0.03) and the overall prevalence of celiac disease in studies that had used biopsy method for diagnosis was observed as 2% (95% CI: 0.01–0.02). Conclusion The prevalence of celiac disease in Iran was similar or even higher than world-wide reported.
Collapse
Affiliation(s)
| | - Rahim Sohrabi
- Ph.D. Student of Health Policy, Iranian Social Security Organization, Zanjan Province Health Administration, Zanjan, Iran
| | - Morteza Salemi
- Ph.D. Student of Health Policy, Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Masood Taheri Mirghaed
- Ph.D. Student of Health Policy, Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Behzadifar
- Ph.D. Student of Health Policy, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
Screening for Celiac Disease in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-analysis. Am J Gastroenterol 2017; 112:65-76. [PMID: 27753436 DOI: 10.1038/ajg.2016.466] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/13/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Celiac disease (CD) and irritable bowel syndrome (IBS) share similar symptoms, leading to confusion between the two and diagnostic delay. International guidelines recommend screening individuals with IBS for CD, via serological testing. However, studies published recently have cast doubt on the utility of this. We updated a previous meta-analysis examining this issue. METHODS MEDLINE, EMBASE, and EMBASE Classic were searched through to May 2016. Eligible studies recruited adults with IBS according to symptom-based criteria, physician's opinion, or questionnaire data. Tests for CD included IgA-class antigliadin antibodies (AGA), endomysial antibodies (EMA), tissue transglutaminase antibodies (tTG), or duodenal biopsies following positive serology. The proportion of individuals meeting criteria for IBS testing positive for CD was combined to give a pooled prevalence for all studies, and compared between cases with IBS and, healthy controls without (where reported), using an odds ratio (OR) with a 95% confidence interval (CI). RESULTS There were 36 eligible studies, recruiting 15,256 individuals, of whom 9,275 (60.8%) met criteria for IBS. Pooled ORs for positive IgA AGAs, EMA and/or tTG, and biopsy-proven CD in IBS subjects vs. controls were 3.21 (95% CI 1.55-6.65), 2.75 (95% CI 1.35-5.61), and 4.48 (95% CI 2.33-8.60), respectively. There was no increase in ORs for any test for CD among cases with IBS in North American studies, and results were inconsistent in population-based studies. The prevalence of biopsy-proven CD was significantly higher across all subtypes of IBS. Limitations included heterogeneity in some analyses, and few North American studies. CONCLUSIONS Overall, prevalence of positive celiac serology and biopsy-proven CD was significantly higher in subjects with symptoms suggestive of IBS vs. healthy controls. However, the utility of screening for CD in individuals with suspected IBS in North America or in the community is less clear.
Collapse
|
5
|
Sánchez-Vargas LA, Thomas-Dupont P, Torres-Aguilera M, Azamar-Jacome AA, Ramírez-Ceervanes KL, Aedo-Garcés MR, Meixueiro-Daza A, Roesch-Dietlen F, Grube-Pagola P, Vivanco-Cid H, Remes-Troche JM. Prevalence of celiac disease and related antibodies in patients diagnosed with irritable bowel syndrome according to the Rome III criteria. A case-control study. Neurogastroenterol Motil 2016; 28:994-1000. [PMID: 26914655 DOI: 10.1111/nmo.12799] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 01/21/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND The cost-effectiveness for screening for celiac disease (CD) in patients with irritable bowel syndrome (IBS), specifically in the diarrhea (IBS-D) subtype, is beneficial if the prevalence is >1%. However, recent studies have shown controversial results. In this large case-control study, our aim was to determine the prevalence of CD and a panel of related antibodies in patients diagnosed with IBS. MATERIALS AND METHODS Four hundred IBS patients (Rome III) and 400 asymptomatic healthy controls were prospectively evaluated using antihuman tissue transglutaminase (h-tTG IgA) and deamidated gliadin peptide antibodies (DGP II IgA and DGP II IgG). Duodenal biopsy was performed on the patients that were positive for the h-tTG IgA and/or DGP II IgG antibodies. RESULTS The mean age of the population was 44.47 ± 18.01 years and 335 (82%) of the subjects were women. Twenty-one patients and six controls had at least one positive test for CD (5.25% VS 1.5%, p = 0.003, OR 3.63 [95% CI 1.4-9.11]). Eighteen patients were positive for h-tTG and/or DGP-II IgG. Histologic confirmation of CD was 2.5% in the IBS patients vs 0.5% in the controls (p = 0.04, OR 5.21). The IBS-D subtype had the highest prevalence for serological positivity (12.7%). CONCLUSIONS Up to 5.2% of the patients with IBS according to the Rome III criteria were positive for at least one of the CD-related antibodies and 2.5% had biopsy-confirmed CD. Therefore, in our population, screening for CD in subjects with IBS appears to be a reasonable strategy, especially in the IBS-D subgroup.
Collapse
Affiliation(s)
- L A Sánchez-Vargas
- Gastrointestinal Motility and Digestive Physiology Laboratory, Medical and Biological Research Institute of the Universidad Veracruzana, Veracruz, Veracruz, Mexico.,Doctorate in Biomedical Sciences, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - P Thomas-Dupont
- Gastrointestinal Motility and Digestive Physiology Laboratory, Medical and Biological Research Institute of the Universidad Veracruzana, Veracruz, Veracruz, Mexico.,Doctorate in Biomedical Sciences, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - M Torres-Aguilera
- Gastrointestinal Motility and Digestive Physiology Laboratory, Medical and Biological Research Institute of the Universidad Veracruzana, Veracruz, Veracruz, Mexico
| | - A A Azamar-Jacome
- Gastrointestinal Motility and Digestive Physiology Laboratory, Medical and Biological Research Institute of the Universidad Veracruzana, Veracruz, Veracruz, Mexico
| | - K L Ramírez-Ceervanes
- Gastrointestinal Motility and Digestive Physiology Laboratory, Medical and Biological Research Institute of the Universidad Veracruzana, Veracruz, Veracruz, Mexico
| | - M R Aedo-Garcés
- Gastrointestinal Motility and Digestive Physiology Laboratory, Medical and Biological Research Institute of the Universidad Veracruzana, Veracruz, Veracruz, Mexico
| | - A Meixueiro-Daza
- Gastrointestinal Motility and Digestive Physiology Laboratory, Medical and Biological Research Institute of the Universidad Veracruzana, Veracruz, Veracruz, Mexico
| | - F Roesch-Dietlen
- Gastrointestinal Motility and Digestive Physiology Laboratory, Medical and Biological Research Institute of the Universidad Veracruzana, Veracruz, Veracruz, Mexico.,Faculty of Medicine Miguel Alemán Valdés, Veracruz, Veracruz, Mexico
| | - P Grube-Pagola
- Gastrointestinal Motility and Digestive Physiology Laboratory, Medical and Biological Research Institute of the Universidad Veracruzana, Veracruz, Veracruz, Mexico
| | - H Vivanco-Cid
- Gastrointestinal Motility and Digestive Physiology Laboratory, Medical and Biological Research Institute of the Universidad Veracruzana, Veracruz, Veracruz, Mexico
| | - J M Remes-Troche
- Gastrointestinal Motility and Digestive Physiology Laboratory, Medical and Biological Research Institute of the Universidad Veracruzana, Veracruz, Veracruz, Mexico.,Faculty of Medicine Miguel Alemán Valdés, Veracruz, Veracruz, Mexico
| |
Collapse
|
6
|
Shalaby SA, Sayed MM, Ibrahim WA, Abdelhakam SM, Rushdy M. The prevalence of coeliac disease in patients fulfilling Rome III criteria for irritable bowel syndrome. Arab J Gastroenterol 2016; 17:73-7. [PMID: 27349575 DOI: 10.1016/j.ajg.2016.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/14/2016] [Accepted: 05/27/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND STUDY AIM The clinical presentation of coeliac disease can vary from a classical malabsorption syndrome to more subtle atypical gastrointestinal manifestations similar to irritable bowel syndrome (IBS). The aim of this study was to investigate the prevalence of coeliac disease in Egyptian patients with clinically diagnosed diarrhoea-predominant IBS (according to Rome III criteria). PATIENTS AND METHODS This study was conducted on 100 patients with clinically diagnosed diarrhoea-predominant IBS (fulfilling Rome III criteria). They were subjected to complete clinical evaluation, routine laboratory investigations, abdominal ultrasonography and serum anti-tissue transglutaminase antibody (anti-tTG) test as a predictor marker for coeliac disease. All patients who tested positive for serum anti-tTG underwent upper gastrointestinal endoscopy with four to eight biopsy samples collected from the second part of the duodenum. RESULTS All of the studied 100 patients presented with abdominal pain or discomfort, flatulence and diarrhoea. Eight patients (8%) exhibited high levels of serum anti-tTG, and their duodenal biopsy samples satisfied the histopathological criteria of coeliac disease. The studied patients were divided into two groups: Group I comprising 92 patients with IBS and negative anti-tTG results and Group II comprising eight patients with IBS and positive anti-tTG results. A non-significant difference was noted between the two groups in age, gender and duration of abdominal pain (p>0.05). The haemoglobin level was found to be significantly reduced in anti-tTG-positive patients (p<0.01), as was the Na level in anti-tTG-negative patients (p<0.05). A highly statistically significant inverse correlation was noted between anti-tTG and both serum total protein and serum albumin. CONCLUSION Some symptoms overlap between coeliac disease and IBS. A lack of awareness may lead to a diagnostic delay in these patients.
Collapse
Affiliation(s)
- Sayed A Shalaby
- Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Moataz M Sayed
- Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Wesam A Ibrahim
- Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sara M Abdelhakam
- Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Marwa Rushdy
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| |
Collapse
|
7
|
The prevalence of celiac disease in patients with irritable bowel syndrome and its subtypes. GASTROENTEROLOGY REVIEW 2016; 11:276-281. [PMID: 28053683 PMCID: PMC5209460 DOI: 10.5114/pg.2016.57941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/22/2015] [Indexed: 12/13/2022]
Abstract
Introduction Irritable bowel syndrome (IBS) and celiac disease (CD) share some gastrointestinal symptoms. Celiac disease should be considered in a differential diagnosis of IBS. Aim To estimate the prevalence of predispositions to CD in patients with IBS and its subtypes. Material and methods The study included 48 patients (40 women, 8 men; average age: 41.1 ±14.6 years) with IBS, and a control group: 20 healthy volunteers. All participants completed a questionnaire on their current gastrointestinal symptoms and had a blood sample taken to determine the HLA-DQ2/DQ8 antigens and serum concentration of anti-tTG IgA and anti-DGP IgA and IgG. Results The presence of HLA-DQ2 or DQ8 was found in 50% of patients (n = 24) with IBS. In the control group the presence of HLA-DQ2 was found in 4 (20%) patients and nobody had HLA-DQ8. Increased levels of anti-tTG IgA were found in 5 (10.42%) patients with IBS, anti-DGP in 4 (8.33%), and anti-DGP IgG in 3 (6.25%). In the control group positive test result for anti-tTG was found in 2 (10%) patients; nobody had elevated anti-DGP IgA or IgG. A concomitant positive result of genetic testing and any elevated serum antibodies specific to CD was found in 12.5% of IBS patients (n = 6) and in none of the control group. Conclusions Patients with IBS, regardless of the subtype, significantly more often than healthy controls have the predisposing genetic factors (HLA-DQ2/DQ8) underlying the development of CD.
Collapse
|
8
|
Yap TWC, Chan WK, Leow AHR, Azmi AN, Loke MF, Vadivelu J, Goh KL. Prevalence of serum celiac antibodies in a multiracial Asian population--a first study in the young Asian adult population of Malaysia. PLoS One 2015; 10:e0121908. [PMID: 25799401 PMCID: PMC4370882 DOI: 10.1371/journal.pone.0121908] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 01/15/2015] [Indexed: 02/06/2023] Open
Abstract
Background Celiac disease (CD) is an immune-mediated disorder induced by the ingestion of gluten in genetically susceptible persons. The prevalence of CD in Malaysia is unknown. We aim to determine the seroprevalence of CD antibodies and also investigate the correlation between H. pylori infection and CD in the young and healthy multiracial Malaysian population. Methods Healthy young adult volunteers between the ages of 18–30 years were consecutively recruited from June 2012 to May 2014 at the University of Malaya Medical Centre (UMMC), Kuala Lumpur. Serum samples from all the participants were tested for anti-gliadin antibody immunoglobulin A/immunoglobulin G (IgA/IgG) and anti-tissue transglutaminase antibody (tTG) IgA/IgG. Samples positive for both anti-gliadin and anti-tTG were further validated for anti-human endomysial IgA antibodies (EmA). Serological diagnosis of CD was made when anti-gliadin, anti-tTG and anti-EmA were positive. Results 562 qualified participants with mean age 24 ± 2.4 years old were recruited into our study. CD was found in 7 participants where most of them were asymptomatic and unaware of their CD status. The median of anti-gliadin and anti-tTG IgA/IgG value was 38.2 U/ml (interquartile range, 28.3–60.4 U/ml) and 49.2 U/ml (interquartile range, 41.1–65.9 U/ml), respectively. Seroprevalence of CD antibodies was 1.9% (6 out of 324) in female while only 0.4% (1 out of 238) in male. Seroprevalence among Malay was 0.8% (2 of 236), Chinese was 1.7% (3 of 177) and Indian was 1.3% (2 of 149). Overall, seroprevalence of CD antibodies in healthy asymptomatic adults in the Malaysian population was 1.25% (95% CI, 0.78%-1.72%). No significant relationship was discovered between CD and H. pylori infection. Conclusions The seroprevalence of CD antibodies in healthy young adults in the Malaysian population was 1.25% (1 in 100). CD is underdiagnosed and it could be a much greater problem in Malaysia than previously thought.
Collapse
Affiliation(s)
- Theresa Wan-Chen Yap
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Weng-Kai Chan
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Alex Hwong-Ruey Leow
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Ahmad Najib Azmi
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Mun-Fai Loke
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Jamuna Vadivelu
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Khean-Lee Goh
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
- * E-mail:
| |
Collapse
|
9
|
Bakhshipour A, Kaykhaei MA, Moulaei N, Mashhadi MA. Prevalence of coeliac disease in patients with non-alcoholic fatty liver disease. Arab J Gastroenterol 2013; 14:113-5. [PMID: 24206739 DOI: 10.1016/j.ajg.2013.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 12/19/2012] [Accepted: 08/20/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND STUDY AIMS Coeliac disease (CD) may be associated with several liver disorders including primary biliary cirrhosis, primary sclerosing cholangitis and autoimmune hepatitis. Furthermore preliminary data suggest a causative role of CD in steatosis and steatohepatitis. The aim of present study was to determine the prevalence of CD in a series of patients with non-alcoholic fatty liver disease (NAFLD). PATIENTS AND METHODS In a cross sectional study (2008-2010), 403 consecutive NAFLD patients (127 female and 276 male) referred to GI clinics of the Zahedan University of Medical Sciences were included. IgA anti-tissue transglutaminase (Anti-tTG) was used for screening of coeliac disease. In the patients with a positive serologic test, duodenal biopsies were taken to confirm the diagnosis. RESULTS The mean±SD of the age and BMI of patients were 37.4±12.4years and 28.3±4.15kg/m(2) respectively. BMIs lower than 25kg/m(2) were found in 58 subjects (14.5%). Furthermore diabetes mellitus and hyperlipidaemia were diagnosed in 48 (11.9%) and 84 (20.8%) individuals respectively. Positive Anti-tTGs were found in 14/403 (3.4%) and 13/403 (3.2%, 95% CI 1.5-4.9) had coeliac disease according to the modified Marsh classification; 8 had type I, 3 type II, 1 type IIIA and 1 type IIIB lesions. CONCLUSION According to our data, prevalence of CD in the subjects with NAFLD is higher than the rates reported in the general population. Therefore screening for CD in selected cases of NAFLD may be appropriate.
Collapse
Affiliation(s)
- Alireza Bakhshipour
- Department of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | | | | |
Collapse
|
10
|
Meng J, Xie CE, Li JX. Advances in research of non-coeliac gluten sensitivity. Shijie Huaren Xiaohua Zazhi 2013; 21:427-433. [DOI: 10.11569/wcjd.v21.i5.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Non-celiac gluten sensitivity (NCGS) is a newly recognized clinical entity that is characterized by a wide variety of intestinal or extra-intestinal manifestations, and it may be the most common one in the spectrum of gluten-related disorders. The symptoms of NCGS improve or disappear after gluten withdrawal and relapse if gluten is reintroduced. There are no specific serological markers for NCGS although nearly half of patients are positive for antigliadin IgG antibodies. Since small intestinal biopsy is normal, the double-blind, placebo-controlled food challenge (DBPCFC) and an exclusion of wheat allergy or coeliac disease are necessary for diagnosis. The pathogenesis is still unclear although immunology may play a role in its pathogenesis. This review will summarize our current knowledge about non-coeliac gluten sensitivity and outline pathogenic and epidemiological differences between NCGS and coeliac disease.
Collapse
|