Non-Celiac Gluten Sensitivity and Celiac Disease Are Different

Category: Other Autoimmune Diseases Published on Monday, 17 March 2014 Written by Yong Tsai, MD

Celiac disease is an autoimmune disorder due to gluten sensitivity, not a food allergy.  Celiac disease affects about 1 percent of the U.S. population.  When people with special genes (HLA DQ2 and/or DQ8) eat wheat, barley, and rye containing gluten, their immune system forms autoantibodies to gluten which, in turn, cause inflammation and attack of the intestinal lining. Patients experience abdominal pain, diarrhea and even weight loss.  Almost all people with Celiac disease have autoantibodies (IgA anti-tissue transglutamine and IgA anti-endomysium).  Because 95 percent of people with Celiac disease have genes of HLA DQ2 and 5 percent have HLADQ8, if you do not have HLA DQ2 or HLADQ8, it is very unlikely you will develop Celiac disease.  Genetic testing is useful when there is a discrepancy between blood tests and small intestine biopsy or genetic counseling of family members.  Though 25-40% of the United States population carries either DQ2 or DQ8, only 2 percent to 3 percent of all people with these genes will ever go on to develop Celiac disease. Therefore, the presence of either gene alone is not a guarantee of developing Celiac disease.

Non-Celiac gluten sensitivity (NCGS) applies to those individuals who cannot tolerate gluten and experience symptoms similar to those of Celiac disease. However, NCGS patients lack the same antibodies and intestinal damage as those with Celiac disease.  NCGS not only has GI symptoms, but it also includes non-GI symptoms such as headache, “foggy mind,” joint pain, and numbness.   In general, the symptoms of Non-Celiac gluten sensitivity are not as severe as Celiac disease. In some cases, patients can eat gluten in moderation.  NCGS is caused by a completely different immune response to gluten from Celiac disease.  NCGS is not an autoimmune disease and does not relate to reactive antibodies or the genes HLA-DQ2 or HLA-DQ8.  While there may be other genes involved in NGCS, more research is necessary to identify a specific genetic link.

Irritable bowel syndrome (IBS) affects up to 15% of the population.  People with IBS may have urgent diarrhea, constipation, a combination of both, or simply have gas and bloating. The etiologies of IBS are not completely clear, however, it is frequently associated with fibromyalgia syndrome.   A subset of people with IBS, but without Celiac disease, suffer from NCGS  and see their IBS symptoms improve or even resolve completely when they eat a gluten-free diet.

Celiac disease, Non-Celiac gluten sensitivity and IBS are different conditions.  Before jumping into a gluten-free diet, the correct diagnosis must be confirmed through patient history, blood tests, small intestine biopsy or even genetic testing. The correct diagnosis is crucial for long term management each specific disorder.

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