Gluten-related disorders

Overview of gluten-related disorders

Gluten-related disorders are a group of conditions that are triggered by the ingestion of gluten, a protein found in wheat, barley, and rye. These disorders include celiac disease, non-celiac gluten sensitivity, wheat allergy, and gluten ataxia.

Celiac Disease

Inflamed mucous layer of the intestinal villi depicting celiac disease

Celiac disease is an autoimmune disorder where the ingestion of gluten leads to damage in the small intestine. It affects about 1% of the population worldwide. The immune response to gluten causes inflammation and damage to the villi, which are small finger-like projections lining the small intestine. This damage impairs nutrient absorption, leading to symptoms such as diarrhea, fatigue, weight loss, and anemia.

Non-Celiac Gluten Sensitivity

Non-celiac gluten sensitivity (NCGS) is characterized by gastrointestinal and extra-intestinal symptoms related to gluten ingestion in individuals who do not have celiac disease or wheat allergy. Symptoms can include abdominal pain, bloating, diarrhea, headache, and fatigue. The pathophysiology of NCGS is not well understood, and diagnosis is typically made by exclusion of other conditions.

Wheat Allergy

Wheat allergy is an allergic reaction to proteins found in wheat, including but not limited to gluten. It is an IgE-mediated response that can cause symptoms ranging from mild (such as hives and itching) to severe (such as anaphylaxis). Wheat allergy is more common in children and may be outgrown with age.

Gluten Ataxia

Video explaining gluten ataxia

Gluten ataxia is a rare neurological condition characterized by the loss of coordination and balance due to gluten ingestion. It is considered an autoimmune disorder where antibodies against gluten attack the cerebellum, the part of the brain responsible for coordination. Early diagnosis and a strict gluten-free diet can help manage symptoms and prevent progression.

Diagnosis

Diagnosis of gluten-related disorders typically involves a combination of serological tests, genetic testing, and biopsy of the small intestine. For celiac disease, the presence of specific antibodies such as anti-tissue transglutaminase (tTG) and anti-endomysial antibodies (EMA) is indicative. Genetic testing for HLA-DQ2 and HLA-DQ8 can support the diagnosis, as these genes are present in most individuals with celiac disease.

Management

The primary treatment for all gluten-related disorders is a strict gluten-free diet. This involves avoiding all foods containing wheat, barley, and rye. Patients are advised to read food labels carefully and be aware of potential cross-contamination in food preparation.

Also see

• Autoimmune disease
• Food allergy
• Gastroenterology
• Neurology