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Does gluten sensitivity in the absence of coeliac disease exist?
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
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
DGOH, Dudley, DY12HQ
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28 December 2012
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
UCL, Whittington Campus, Highgate Hill, London N19 5LW
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