Non-coeliac gluten sensitivity

Re: Non-coeliac gluten sensitivity

20 December 2012

I enjoyed the articles on non-gluten sensitivity (1,2). Publication of these articles in the BMJ gives respectability to an entity which has been recognised increasingly over the last 10 years. This is very different to the situation in the 1970s. The distinguished Birmingham gastroenterologist, Dr Trevor Cooke, recognised that not all gluten sensitive patients had coeliac disease. His group reported eight patients with diarrhoea who were shown to be gluten sensitive by gluten elimination and challenge but who did not have coeliac disease by the criteria of the time (3). These patients had minor abnormalities of jejunal mucosal cellularity but no evidence of villous atrophy. Anti-gluten antibodies were not present . Unfortunately this study predated the availability of endomyseal and tissue transglutaminase antibodies. There were no abnormalilties in serum IgE levels.

At that time, the attitude of the gastroenterological community to the concept of non-coeliac gluten sensitivity ranged from profoundly sceptical to ferociously hostile. It is gratifying that, after so many years, the concept of non-coeliac gluten sensitivity is accepted and is being actively studied.

Yours faithfully,
Brian Cooper

References
1. Anonymous, Rostami K, Hogg-Kollars S. Non coeliac gluten sensitivity. BMJ 2012;345:e7982
2. Aziz I, Hadjivassiliou M, Sanders D. Does gluten sensitivity in the absence of coeliac disease exist? BMJ 2012; 345: e7907.
3. Cooper BT, Holmes GKT, Ferguson R, Thompson RA, Allan RN, Cooke WT. Gluten sensitive diarrhoea without evidence of celiac disease. Gastroenterology 1980; 79: 801-6.

Competing interests: None declared

Brian T Cooper, Consultant gastroenterologist

City Hospital , Dudley Rd, Birmingham B18 7QH

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