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Study Defines Difference Between Celiac Disease and Gluten Sensitivity

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Celiac disease and gluten sensitivity are on same spectrum, but immune response is entirely different.

The medical and scientific community has long agreed that celiac disease is an autoimmune condition triggered by the consumption of gluten. In recent years, the term "gluten sensitivity" has been coined to describe those individuals who also cannot tolerate gluten and at times experience gastrointestinal symptoms similar to those with celiac disease. Gluten sensitivity has been clinically recognized as less severe than celiac, and has been defined as "not accompanied by the concurrence of tTG or autoimmune comorbidities."

Now, a new study is offering long-awaited answers about the different ways celiac disease and gluten sensitivity operate.

 A research team led by renowned celiac expert Alessio Fasano, MD, has discovered that gluten sensitivity is associated with an immune response that is very different from the response seen in celiac disease patients. Until now, little has been known about gluten sensitivity. Researchers hope this breakthrough leads to better diagnosis of the condition.

The study included individuals with celiac disease, gluten sensitivity and healthy gluten-tolerant controls. Participants were placed on a 4-month gluten challenge, then underwent serological screening for celiac disease, HLA DQ2/DQ8 typing and an upper endoscopy including duodenal biopsy.

According to the results, individuals with gluten sensitivity showed no signs of intestinal damage or increased permeability, but showed an increase in an innate immunity marker. This is different from the immune response seen in celiac disease, which is noted by an increase in an adaptive immune marker. Among gluten sensitive participants, this adaptive immune marker was lower than the level found in participants with celiac.

Researchers concluded that celiac disease and gluten sensitivity are “different clinical entities,” marked by unique immune responses. Further research is needed to get a better understanding of these differences and how they could affect diagnosis of the conditions.

To learn more, read the study in BMC Medicine.

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