Celiac Disease vs Non Celiac
Gluten Sensitivity vs
October 5, 2015
By Emily Hullinger
Differences between Celiac Disease, Non Celiac Gluten Sensitivity, and
Identify signs and symptoms of Celiac Disease, Non Celiac Gluten
Sensitivity, and Wheat allergies.
Diagnosis of Celiac Disease, Non Celiac Gluten Sensitivity, and Wheat
What is Celiac Disease (CD)?
Lifelong, genetically based autoimmune disorder causing inflammation of
the proximal small intestine.
T-cell mediated immune response to gluten from wheat, rye, and barley
which can lead to villous atrophy, crypt hyperplasia and inflammation in
the small intestine.
Prolamins: gliadin, secalin, horedin, and sometimes avenin.
Development of Celiac Disease
Two main conditions must be necessary for development:
The ingestion of gluten.
Genetic predisposition to celiac disease.
The Human leukocyte antigens (HLA) found in CD positive patients are HLA
DQ2 and HLA DQ8.
Some people have these HLA alleles but most do not develop CD
Pruritic lesions that occur over the surface of elbows, knees, legs, buttocks,
trunk, neck, or scalp.
How is Celiac Disease Diagnosed?
Testing for celiac disease involves a celiac blood test and biopsy sample
from multiple areas of the intestine, including the duodenal bulb.
IgA anti-TG2 antibody, IgG/IgA anti-demaidated gliadin antibody indicate Celiac Disease.
Family medical history, physical exams, and a skin biopsy can also help
If someone is suspecting CD, they must be consuming gluten in their diet
for accurate results.
MNT for CD
Strict GF diet (eliminating wheat, rye, barley and sometimes oats)
Defects from consumption are permanent. Once mucosa of SI is damaged, it
cannot be reversed.
Greek-Mediterranean diet with olive oil, nuts, fruits, and vegetable intake.
May prevent nutrition deficiencies: iron deficiency anemia, protein-calorie
malnutrition, zinc, folic acid, selenium, and vitamins B6, B12, D, E, and K.
What is Non Celiac Gluten Sensitivity
The cause of NCGS is not-well understood and may be different for each
Etiology and pathophysiology is still being researched.
A form of gluten intolerance that does not meet diagnostic criteria for celiac
disease or wheat allergy.
Symptoms of Non Celiac Gluten
Diarrhea, abdominal discomfort, pain, bloating, and flatulence.
Malnutrition of nutrients due to decreased absorption of gluten.
Fatigue, headache, brain fog, lethargy
Dermatitis, skin rashes.
Sensitivities do not cause permanent GI or organ damage once the acute
reaction is resolved.
How is Non Celiac Gluten Sensitivity
No specific blood tests for this condition, still under investigation.
When doctors have rules out Celiac Disease and Wheat allergy.
Pre-requisites that may indicate NCGS:
Serologic negativity to anti-transglutaminase IgA and anti-wheat component IgE
Absence of duodenal atrophies and skin reactions from a prick test.
Lundin KEA, Alaedini A. Non-celiac Gluten Sensitivity.
Gastrointestinal Endoscopy Clinics of North America
MNT for Non Celiac Gluten Sensitivity
Trial wheat, barley, rye and oat products.
Eat gluten products as tolerated.
If omitting gluten products:
Aim for a diet higher in B vitamins, iron, protein, zinc, folic acid, selenium, and
vitamins D, E, and K.
What is a Wheat Allergy?
Immune-mediated overreaction to proteins found in wheat products.
IgE-mediated reaction to the water and salt-insoluble gliadins, specifically
ω-5 gliadin can cause wheat-dependent exercise-induced anaphylaxis or
Symptoms of Wheat Allergies
Swelling, itching, and irritation of mouth, nose, eyes and throat.
Rashes, hives, and swelling of the skin.
Wheezing, difficulty breathy, anaphylaxis of the respiratory tract.
Cramps, emesis, gas, bloating, diarrhea, and abdominal pain.
Wheat Allergies do not cause permanent GI or organ damage once the acute
reaction is resolved.
How are Wheat Allergies Diagnosed?
Skin Prick tests
Oral food challenge
MNT for Wheat Allergies
Avoid products with wheat.
More liberal diet than CD, patients do not need to restrict other
prolamin-containing grains (rye, barely, and oats).
Ideal to have epinephrine available with meals in case of
anaphylactic (life threatening) reaction.