Sensibilidade ao glúten não celíaca: um diagnóstico desafiador entre as desordens associadas ao glúten

Abstract

The aim of this article is to analyze the current diagnostic criteria for non-celiac gluten sensitivity (NCGS), since there is still no well-defined protocol for investigating this clinical condition, based only on the exclusion of other pathologies such as celiac disease and wheat allergy. The following words were used as search descriptors: wheat hypersensitivity, diarrhea, abdominal pain, gluten-free diet. The Boolean operators AND and OR were used in the following databases: Scielo and PubMed. Finally, publications in Portuguese and English in the last five years, between January 2019 and April 2024, were included. The clinical presentation of NCGS involves a variety of symptoms, including both intestinal and extraintestinal symptoms. These symptoms generally appear after ingestion of gluten/wheat and improve with its cessation. The main pathophysiological mechanisms of NCGS in the face of intestinal exposure to gluten and polyphenols described were: immediate inflammatory response by gluten; intestinal barrier dysfunction; intestinal dysbiosis; immune inflammatory response. Removing gluten or wheat from the diet has been endorsed by many authors as an effective approach to treating NCGS. The lack of specific biomarkers and the non-specificity of the symptoms make diagnosis a difficult task and is often based on excluding other gluten-related pathologies. Finally, the gluten-free diet faces difficulties in long-term adherence, high food costs and the possibility of causing nutritional deficiencies. In addition, the controlled reintroduction of gluten and the consideration of individual tolerance highlight the need for a personalized and multidisciplinary approach in the management of NCGS.