Gluten is a protein found in grains like wheat, barley, or rye. Valued for centuries, it provides dough with its elastic properties and helps bread to rise. Gluten also gives bread a chewy texture, which makes it tasty. Unfortunately, the benefits end there. Gluten can trigger inflammation in the GI tract and lead to diseases like celiac sprue. Scientists and doctors are now finding that the inflammation triggered by gluten can result in a variety of conditions beyond celiac sprue. They are calling one of those conditions "non-celiac gluten sensitivity," and it is estimated that as many as 18 million Americans may suffer from it.
The symptoms of celiac sprue, also called celiac disease, were discovered in 1856. Despite the early understanding, celiac disease seemed to have garnered little attention from the medical establishment until the 1960s when the genetic underpinnings of the disease were revealed. Despite this genetic understanding, it took several decades before adequate testing methods became available as it took a bit longer for physicians to fully grasp the prevalence of celiac disease. Many patients were mistakenly labeled as having irritable bowel syndrome before specific testing became more prominent.
While not entirely clear how the disease process plays out, it is now well-established that celiac sprue is an autoimmune disorder. A part of the gluten protein, called gliadin, can trigger an immune reaction. Antibodies are formed against gliadin and can, in people with a certain genetic makeup, also react with the cells that line the intestines. The result of this cross reaction is the autoimmune destruction of the intestinal lining. Loss of the lining of the intestine causes pain, loose stool, flatulence and other gastrointestinal (GI) symptoms of celiac disease.
Previously thought that celiac disease affects roughly 1 in 1800 people, it is now understood that the disorder affects more like 1 in 100 people. In other words, it is eighteen times more common than first suspected. This new understanding of the disease's prevalence has led to the manufacture of a number of gluten-free products to help ease the nutritional woes of those who suffer from the condition. More importantly, it has led to enhanced interest in autoimmune diseases that originate in the GI tract.
NON-CELIAC GLUTEN SENSITIVITY
Medical science has come a long way in its understanding of gastrointestinal disorders in general and celiac disease in particular. Recently, however, doctors have encountered a new problem. More and more people are demonstrating symptoms that are nearly identical to those of celiac disease. The problem is, these individuals lack diagnostic antibodies and have no biopsy findings. They have all of the symptoms of celiac disease, and even respond to gluten-free diets, but they meet none of the diagnostic criteria.
While it would be easy to ignore one or two cases with the features described above, medical science cannot ignore the thousands that are presenting all over the world. Estimates of the prevalence of celiac disease indicate that it probably affects about 3 million Americans. Surprisingly, new evidence has revealed that as many as 18 million Americans may be sensitive to gluten but never show signs of it on currently available tests. These people are being placed into a new category called non-celiac gluten sensitivity (NCGS).
WHICH IS IT, CELIAC DISEASE OR NCGS?
At this point, some individuals might be tempted to skip the medical testing and simply stop eating gluten. After all, it seems like the available choices are either NCGS or celiac disease, both of which are treated by a gluten-free diet. Such a decision would be hasty, however, as there are a number of differences between NCGS and celiac disease that make obtaining an accurate diagnosis important.
First, celiac sprue has been linked to certain types of cancer. Though developing cancer as a result of celiac disease is rare, it is still a possibility that needs to be taken into consideration. Careful monitoring by a doctor who understands celiac sprue and its complications is important for ensuring good health. So far, no link between NCGS and any other condition has been made.
Second, celiac disease and non-celiac gluten sensitivity appear to arise from two different disease processes. The result is two different responses to a gluten-free diet. In celiac disease, any contact with gluten causes an immediate allergic reaction along with pain, bloating, and diarrhea. On the other hand, many people who suffer from NCGS are able to add small amounts of gluten to their diets after abstaining long enough for the original symptoms to resolve. Given the difficulty of adhering to a gluten-free diet, the ability to consume it in any quantity may make life a bit easier.
Finally, celiac disease has a strong genetic component. If an individual suffers from celiac-like symptoms, knowing that the disease runs in his or her family can lead to prompt diagnosis and thus prompt treatment. Right now, it isn't clear if NCGS has a genetic link or not. What is clear is that while the two diseases are at least marginally related, they do appear to arise from two different biologic mechanisms and thus have important, though subtle, differences.
WHAT SHOULD YOU DO ABOUT GLUTEN SENSITIVITY?
If you think you suffer from gluten sensitivity, it is important to get tested before going on an elimination diet. If you eliminate gluten before being tested, it is possible that your antibody count will drop below a detectable level. In that case, you will fail to be diagnosed with celiac disease even though you really have it. Getting an accurate diagnosis is important because it allows you to engage in proper follow-up, undertake necessary dietary measures, and discuss your diagnosis with family members who may be at risk of developing celiac disease. Additionally, assuming that your symptoms are due to gluten sensitivity can be dangerous because other serious disorders can mimic both celiac disease and NCGS. It is always best to obtain the advice of a physician in order to get as accurate a diagnosis as possible. That way, you won't be back to square one if your gluten-free diet fails.
Urgent Clinics Medical Care offers friendly, experienced and licensed professionals ready to assist you and your family with gastrointestinal issues. By ordering blood tests, x-rays or outpatient CT scans we are able to rule out dangerous diagnoses or refer to a specialist. For a patient with chronic pain, we refer to a gastroenterologist for further evaluation. Walk-ins are welcome at our urgent care clinics located in Pearland, Houston, Champions, The Woodlands and League City; Creekside, Marina Bay, and Tuscan Lakes.