Non-celiac wheat sensitivity: separating the wheat from the chat!

Historically, it has been reported that patients with undetected celiac disease (CD) may present with irritable bowel syndrome (IBS) type symptoms. This has led to the recommendation by the American College of Gastroenterology Task force that patients presenting with diarrhea predominant IBS type symptoms should be serologically tested for CD. Concurrently speculative media data suggest that the US general public have increased their uptake of a gluten-free diet (GFD) far in excess of the known prevalence of CD. This may suggest that individuals with gastrointestinal symptoms are deriving benefit from a GFD even if they do not have CD. This has led to the scientific community considering the evidence for an emerging concept of non-celiac wheat sensitivity. There is a significant disparity in our views about what this phenomenon may be. There is also confusion about the nomenclature for this entity and indeed whether patients are suffering due to symptoms related to gluten or perhaps other components of wheat, for example fructans. In this month's edition of the American Journal of Gastroenterology, we see evidence to support the clinical concept of wheat sensitivity or intolerance. Irrespective of the nomenclature Carroccio provides a clinically applicable approach that may be adopted internationally by clinicians. This offers a new option in our armamentarium when seeing patients with IBS type symptoms.