FAQ: Celiac Disease vs. Non-Celiac Gluten Sensitivity
Many people experience digestive problems like bloating or constipation after consuming gluten-rich foods. This reaction is different from a wheat allergy, which can be a life-threatening response to ingesting or even inhaling wheat. Celiac disease and non-celiac gluten sensitivity (NCGS) are two conditions that can cause similar gastrointestinal symptoms but have distinct differences. Dr. Natalie Hoffmann, an attending physician in Lurie Children's Division of Gastroenterology, Hepatology, and Nutrition, answers some of the most frequently asked questions about celiac disease and gluten intolerances.
What is gluten?
Gluten is a general name for a protein found in wheat, rye, barley, triticale, and malt that helps food maintain its shape. Gluten is most commonly found in pastas, noodles, breads, crackers, baked goods, and flour tortillas, but there are many foods that may contain hidden sources of gluten. Fortunately, there are many foods that are naturally gluten-free or have gluten-free alternatives that enable individuals with celiac disease to maintain a healthy balanced diet.
For individuals diagnosed with celiac disease, gluten must be avoided. Some patients with non-celiac gluten sensitivity can tolerate cross-contamination, or small amounts of gluten without worsening symptoms, while others need a strict gluten-free diet. Education by a dietician trained in gluten-related disorders is important for patients and families to maintain a nutritionally complete and balanced diet.
What is the difference between celiac disease and gluten sensitivity?
Celiac disease is a lifelong, immune-mediated disease of the gastrointestinal system that is triggered by gluten. For individuals with celiac disease, an abnormal immune response to gluten can cause intestinal inflammation and damage that can also affect nutrient absorption and growth.
Non-celiac gluten sensitivity (NCGS) is a syndrome that causes a variety of intestinal and non-intestinal symptoms that generally occur hours to days after eating gluten-containing foods. NCGS is diagnosed after celiac disease and wheat food allergy have been ruled out as the cause.
Celiac Disease vs. Non-Celiac Gluten Sensitivity Symptoms
|Celiac Disease Symptoms||NCGS Symptoms|
How common is celiac disease or gluten sensitivity in children?
Celiac disease is estimated to affect 1% of the population worldwide. Celiac disease is caused by an abnormal immune system response to gluten in genetically predisposed people, so individuals with first-degree relatives with celiac disease and other certain medical conditions are more susceptible. This means that genes, the environment, and the immune system play a role.
The prevalence of non-celiac gluten sensitivity is estimated at 0.5-13% worldwide, but the cause is not well understood. In individuals with NCGS, exposure to gluten leads to intestinal and non-intestinal symptoms that are not caused by an allergic reaction or autoimmune response. There is no established genetic basis to non-celiac gluten sensitivity, but it is important to test for celiac disease and a wheat allergy prior to eliminating gluten.
How is celiac disease diagnosed and treated?
Evaluation for celiac disease typically starts with screening blood tests that assess for specific antibodies and tests that rely on gluten consumption. A physician may also perform an upper gastrointestinal endoscopy to obtain small pieces of tissue that are reviewed under a microscope to assess for inflammation and damage to the intestines.
Celiac disease is treated with complete exclusion of gluten from the diet. Many foods, especially processed foods, can have gluten. It is very important to meet with a trained dietician with expertise in celiac disease to review hidden sources of gluten exposure. Nutritional counseling is also helpful for learning about gluten-free alternatives and resources for maintaining a balanced and healthy gluten-free diet. Follow up visits with a pediatric gastroenterologist are important for monitoring growth, screening for nutrient deficiencies, and assessing adherence to gluten-free diet.
Does celiac disease have long-term health effects?
Untreated celiac disease causes damage to the small intestine that impacts the body’s ability to absorb important nutrients for healthy growth. It has also been associated with an increased risk of certain gastrointestinal cancers. The long-term health effects of undiagnosed or untreated celiac disease includes malnutrition, vitamin and mineral deficiencies, anemia, poor bone health, and neurological symptoms such as headaches/migraines, seizures, and behavior problems.
There are no established long-term health effects of non-celiac gluten sensitivity. It is important to regularly follow with your doctor to monitor growth and assess risk for nutrient deficiencies on the gluten-free diet.
How is gluten sensitivity diagnosed?
There are currently no tests available for non-celiac gluten sensitivity. The diagnosis is based on the exclusion of celiac disease and wheat allergy, and symptom development after removing gluten from the diet. The symptoms of NCGS vary and can include intestinal and non-intestinal symptoms, typically occurring within hours to days after gluten ingestion. This is different from wheat allergy in which symptoms can occur within minutes to hours, and also different from celiac disease in which symptom development can vary from days to weeks.
It is important for individuals that suspect a sensitivity to gluten be tested for celiac disease before trialing gluten-free diets. Once gluten is removed from the diet it can be very difficult to differentiate between celiac disease, wheat allergy, and non-celiac gluten sensitivity. Accurate diagnosis is additionally important because some patients with NCGS may be able to tolerate gluten-containing foods over time or “outgrow” the condition, unlike celiac, which is a lifelong disease.
How is a gluten sensitivity treated?
Non-celiac gluten sensitivity is managed by assessing symptoms after removing gluten from the diet while ensuring healthy nutrition and growth. Some patients with suspected NCGS instead respond to removal of other types of carbohydrates found in many wheat products. It is important to discuss diet adjustments with your doctor to ensure adequate intake of vitamins, minerals, and nutrients needed for healthy growth and development.