Pediatric noncoeliac gluten sensitivity

Abstract

Functional gastrointestinal disorders remain a rather obscure and vague chapter of medicine, clouded with discordant, or even completely contradictory findings and opinions, depending on the different researchers and studies. The two main etiological hypotheses are an alteration of the brain-gut axis with visceral hypersensitivity, or a microscopic inflammation of the gastro-intestinal mucosa. However, what appears to link these and other hypotheses is the evidence that the symptoms reported by patients, both in adults and in the pediatric age, are very often presented in association with the intake of specific foods. To further complicate this heterogeneous situation, several authors have reported cases of patients without the celiac disease (CeD) or wheat allergy (WA) criteria, who referred a marked improvement in gastro-intestinal functional symptoms on a gluten-free diet (GFD). This condition was initially defined as ‘gluten sensitivity’ (GS), only to be changed to ‘non-celiac gluten sensitivity’ (NCGS), to better differentiate it from CeD, and finally redefined as ‘non-celiac wheat sensitivity’ (NCWS), as it is still not certain even today which of the components of wheat is the real culprit of this pathology. To date, this is one of the most studied and controversial areas of research in the gastroenterological field, with data that, at least in part, seem to indicate that NCGS/NCWS in adults could represent a form of non-IgE-mediated allergic reaction that has its roots in some clinical reactions already in the pediatric age