From the Guidelines
Symptoms of Non-Celiac Gluten Sensitivity (NCGS) or Celiac Disease (CD) typically include gastrointestinal symptoms such as diarrhea, nausea, vomiting, and abdominal pain, as well as extraintestinal symptoms like fatigue and weight loss. According to the most recent study 1, symptomatic coeliac disease is characterized by these symptoms, which can vary in severity and presentation. The study highlights that coeliac disease is estimated to affect around 1% of people in the UK, but only 24% of those with coeliac disease are thought to be diagnosed, leading to a significant impact on quality of life.
Some of the common symptoms of NCGS or CD include:
- Digestive issues such as bloating, diarrhea, constipation, abdominal pain, and nausea after consuming gluten-containing foods
- Fatigue, headaches, brain fog, joint pain, skin rashes (particularly dermatitis herpetiformis), depression, anxiety, and anemia
- Symptoms can vary widely in severity and may appear hours or days after gluten consumption
It is essential to note that the diagnosis of coeliac disease is based on a combination of serological tests for coeliac-specific antibodies and endoscopic intestinal biopsy, as recommended by current guidelines 1, 2, 3. For proper diagnosis, it is crucial to consult a healthcare provider before eliminating gluten from the diet, as they may recommend testing for celiac disease, which requires gluten consumption for accurate results. The American College of Gastroenterology (ACG) guidelines 3 recommend that all diagnostic serologic testing for celiac disease should be performed before a gluten-free diet is initiated, and that antibodies directed against native gliadin are no longer recommended for primary detection.
In terms of diagnosis, the most recent study 1 suggests that serological tests, such as immunoglobulin A (IgA) anti-tissue transglutaminase (tTG) antibody, are highly sensitive and specific in both adults and children. However, intestinal biopsy is still considered the gold standard for diagnosis, particularly in cases where serological tests are inconclusive or negative. The British Society of Gastroenterology guidelines 2 recommend that patients with suspected coeliac disease should undergo serological testing for total immunoglobulin A (IgA) and IgA anti-tissue transglutaminase (tTG), and that those with positive results should be referred for intestinal biopsy.
Overall, the symptoms of NCGS or CD can be diverse and non-specific, making diagnosis challenging. However, with the help of serological tests and intestinal biopsy, healthcare providers can accurately diagnose and manage coeliac disease, improving the quality of life for affected individuals.
From the Research
Symptoms of Non-Celiac Gluten Sensitivity (NCGS) and Celiac Disease (CD)
- Symptoms of Celiac Disease (CD) include: + Typical gastrointestinal symptoms such as diarrhea, steatorrhea, weight loss, bloating, flatulence, and abdominal pain 4 + Non-gastrointestinal abnormalities like abnormal liver function tests, iron deficiency anemia, bone disease, skin disorders, and other protean manifestations 4 + Some individuals with CD may have no symptoms at all 4
- Symptoms of Non-Celiac Gluten Sensitivity (NCGS) are similar to CD, with systemic symptoms occurring after gluten ingestion, but without small bowel atrophy or abnormal celiac serologies 5
- Common manifestations of CD and NCGS include: + Diarrhea 6 + Weight loss 6 + Abdominal pain 6 + Bloating 6 + Malabsorption 6 + Failure to thrive 6 + Anemia 6 + Osteoporosis 6 + Transaminitis 6 + Recurrent miscarriage 6
Diagnosis and Treatment
- Diagnosis of CD is typically done through serologic testing of celiac-specific antibodies and duodenal mucosal biopsies, while NCGS diagnosis is based on symptom remission after removing gluten from the diet 4, 6, 5
- Treatment for both CD and NCGS involves a gluten-free diet (GFD), which requires significant patient education, motivation, and follow-up 7, 4, 6, 5