Uncertainties Page

Does gluten sensitivity in the absence of coeliac disease exist?

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7907 (Published 30 November 2012)
Cite this as: BMJ 2012;345:e7907

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I enjoyed the paper by Imran Aziz and colleagues. Authors attempted to resolve uncertainties about this newly recognized entity. Advising patients to stick to a gluten free diet for life is a decision that should not be considered lightly. The big challenge we face is to diagnose true gluten sensitivity as it is well known that stopping fermentable fructans (present in wheat) improves symptoms of irritable bowel syndrome. There is a great need to focus research to identify serological markers to identify this condition accurately. Equally important is to establish objective criteria to assess the response to a gluten free diet rather than relying on subjective improvement in patients' symptoms.

yours faithfully

Sauid Ishaq

sauid@doctors.org.uk

1-Aziz I, Hadjivassiliou M, Sanders D. Does gluten sensitivity in the absence of coeliac disease exist? BMJ 2012; 345: e790

Competing interests: None declared

Sauid Ishaq , Gastroenterologist

DGOH, Dudley, DY12HQ

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Some years ago, suffering increasing gastro-intestinal symptoms, it was suggested that I try a gluten-free diet. Symptoms rapidly disappeared. Investigations for coeliac disease seemed sensible and were performed.

After which, I saw the gastroenterologist. With a smile on his face, he told me I was fine, I didn't have coeliac disease. I found this very upsetting. While glad not to have coeliac, being told I was fine felt like a denial of my symptoms, as if the NHS was washing its hands of me.

We train our doctors in how to break bad news, but perhaps we need to train them in how to break good news. With non-coeliac gluten sensitivity and in other situations, ruling out a serious condition is good news, but not the end of the story.

Competing interests: None declared

Henry W Potts, Senior Lecturer

UCL, Whittington Campus, Highgate Hill, London N19 5LW

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