Intended for healthcare professionals

Clinical Review State of the Art Review

Celiac disease and non-celiac gluten sensitivity

BMJ 2015; 351 doi: (Published 05 October 2015) Cite this as: BMJ 2015;351:h4347
  1. Benjamin Lebwohl, assistant professor of medicine and epidemiology12,
  2. Jonas F Ludvigsson, professor23,
  3. Peter H R Green, professor of medicine1
  1. 1Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
  2. 2Department of Medical Epidemiology and Biostatistics, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
  3. 3Department of Pediatrics, Örebro University Hospital, Sweden
  1. Correspondence to: PHR Green PG11{at}


Celiac disease is a multisystem immune based disorder that is triggered by the ingestion of gluten in genetically susceptible individuals. The prevalence of celiac disease has risen in recent decades and is currently about 1% in most Western populations. The reason for this rise is unknown, although environmental factors related to the hygiene hypothesis are suspected. The pathophysiology of celiac disease involves both the innate and adaptive immune response to dietary gluten. Clinical features are diverse and include gastrointestinal symptoms, metabolic bone disease, infertility, and many other manifestations. Although a gluten-free diet is effective in most patients, this diet can be burdensome and can limit quality of life; consequently, non-dietary therapies are at various stages of development. This review also covers non-celiac gluten sensitivity. The pathophysiology of this clinical phenotype is poorly understood, but it is a cause of increasing interest in gluten-free diets in the general population.


  • Contributors: All three authors participated in all four components of authorship: the conception or design of the work; the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; and final approval of the version to be published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. PHRG is guarantor.

  • Funding: BL: National Center for Advancing Translational Sciences, National Institutes of Health (UL1 TR000040). JFL: Örebro University Hospital, Karolinska Institutet, the Swedish Society of Medicine, the Swedish Research Council—Medicine (522-2A09-195), and the Swedish Coeliac Society.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: PHRG serves on the scientific advisory boards of Alvine Pharmaceuticals and ImmusanT. The other authors have no competing interests.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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