"We are all on a learning curve," says UK expert.
The following press release is from United European Gastroenterology (UEG).
(Berlin, October 15, 2013) The newly-emerged clinical syndrome non-celiac gluten sensitivity continues to puzzle gastroenterologists and other medical professionals, as scientists and clinicians grapple to understand the condition and how best to manage it. Professor David Sanders from the Sheffield Teaching Hospitals in Sheffield, UK, and Chairman of the Health Advisory Committee for the respected UK charity Coeliac UK, told journalists at the 21st United European Gastroenterology Week (UEG Week) in Berlin, Germany, that a careful diagnosis to exclude celiac disease, good patient education and cautious use of a gluten-free diet may be key to effective symptom control in this condition. “Public awareness of gluten-related symptoms is rising, if not mushrooming,” he said. “But we shouldn’t rush into prescribing a gluten-free diet to everyone who reports gluten sensitivity. We are still on a learning curve ourselves about this condition and its natural history, and patients need to understand that.”
Until relatively recently, the most well-known medical condition associated with gluten sensitivity was celiac disease. This is caused by an immune response to the cereal protein gluten in susceptible people, and a life-long gluten-free diet is the only treatment available.
It is now widely accepted that gluten sensitivity can also occur in people without celiac disease. Non-celiac gluten sensitivity (NCGS), as it is known, is associated with a similar range of acute symptoms to celiac disease, making it difficult to differentiate between the two conditions based on symptoms alone. NCGS is diagnosed by a process of exclusion and currently there is no biomarker to detect it. It seems likely that NCGS is far more prevalent than celiac disease, with a recent UK study1 suggesting that, out of every 100 patients with gluten sensitivity referred for specialist investigation, 10 will be diagnosed with celiac disease and 90 will have NCGS.
Prof. Sanders thinks the best way for doctors to approach patients who present with symptoms relating to eating gluten is to focus on excluding celiac disease using blood tests and, where necessary, gastroscopy with a biopsy of the small bowel, ensuring patients are eating a normal diet at the time of investigation. Although a gluten-free diet may provide symptomatic relief for some patients with NCGS, in Prof. Sanders’ opinion, a gluten-free diet should not be prescribed immediately to individuals diagnosed with NCGS.
“I believe we should reassure patients that they do not have celiac disease and therefore their risk of complications is lower,” he said. “We should explain that we, as doctors, are still learning about this condition before discussing with them the possible role of a gluten-free diet in the future. Depending on how symptoms progress after the diagnosis, patients may choose to reintroduce a gluten-free diet at a later date or they may be able to gradually increase their gluten intake.”
- Aziz I, Lewis NR, Hadjivassiliou M, et al. The population prevalence of self-reported gluten sensitivity and referral characteristics to secondary care. Presentation at UEG Week 2013, Berlin, October 12–16, 2013 (abstract UEG13-ABS-1738).
For further information about the topics of the UEG Week press conference please follow this link:
UEG, or United European Gastroenterology, is a professional non-profit organisation combining all the leading European societies concerned with digestive diseases. Together, its member societies represent over 22,000 specialists, working across medicine, surgery, paediatrics, gastrointestinal oncology and endoscopy. This makes UEG the most comprehensive organisation of its kind in the world, and a unique platform for collaboration and the exchange of knowledge. Visit www.ueg.eu