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New understanding of gluten sensitivity

Nature Reviews Gastroenterology & Hepatology volume 9, pages 295–299 (2012)Cite this article

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Abstract

Among gluten-related disorders, gluten sensitivity is an emerging entity that is characterized by a wide array of manifestations. In particular, patients complain of IBS-like symptoms and extraintestinal manifestations that occur shortly after the ingestion of gluten. Symptoms improve or disappear when gluten is withdrawn from the diet, and recur if gluten is reintroduced. Laboratory tests are usually unhelpful for diagnosis, although ∼50% of patients are positive for IgG antigliadin antibodies. The natural history of gluten sensitivity is unknown; in particular, it is still to be clarified whether this disorder is permanent or transient and whether it is linked to autoimmunity. The pathogenesis of gluten sensitivity is unclear; data so far demonstrate a predominant activation of innate immune responses. Further research is necessary to establish the main clinicopathological features of gluten sensitivity, thus enabling physicians to improve their management of the increasing number of patients who are sensitive to dietary gluten.

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Figure 1: Pathogenic mechanisms of gluten sensitivity and celiac disease.
Figure 2: Symptoms reported by 78 patients with gluten sensitivity; most patients complained of two or more symptoms.25

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Acknowledgements

The authors would like to acknowledge the support of grants PRIN/COFIN from the Italian Ministry of University, Research and Education 2008 and 2010, RFO funds from the University of Bologna and research grants from Fondazione Del Monte di Bologna e Ravenna.

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  1. Departments of Clinical Medicine and Digestive Diseases & Internal Medicine, University of Bologna and St Orsola-Malpighi Hospital, Via Massarenti 9, Bologna, 40138, Italy

    Umberto Volta & Roberto De Giorgio

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Both authors contributed equally to all aspects of this article.

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Correspondence to Umberto Volta.

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Volta, U., De Giorgio, R. New understanding of gluten sensitivity. Nat Rev Gastroenterol Hepatol 9, 295–299 (2012). https://doi.org/10.1038/nrgastro.2012.15

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