Journal of Neurogastroenterology and Motility : eISSN 2093-0887 / pISSN 2093-0879

Table. 1.

Differentiating Features Between Celiac Disease, Non-celiac Gluten Sensitivity and Wheat Allergy

Celiac disease NCGS Wheat allergy
Prevalence 0.5-2.0% 0.6-6.0% 0.4-1.0% in children
Age of presentation Childhood and adulthood Mostly adulthood (3rd-4th decade) Mostly childhood (1st decade)
Sex F > M (1.3:1-2:1) F > M (3:1-5.4:1) M > F
Onset of symptoms after gluten exposure Weeks-years Hours-days Minutes-hours
Pathogenesis Autoimmunity (adaptive immunity) Poorly understood, role of both innate and adaptive immunity Allergic immune response (IgE antibody against wheat proteins)
Clinical featuresIntestinal Chronic diarrhea, abdominal pain, bloating Diarrhea, abdominal pain, bloating Less often
Extra-intestinal Anemia
Neurological symptoms (ataxia, peripheral neuropathy)
Growth retardation
Lack of well-being, headache, foggy mind, fatigue
Numbness of limbs
Joint/muscle pain
Oral/tongue lesions
More often
Skin rashes urticaria Angioedema, asthma, cough
Serology IgA anti-tTG Ab
IgA anti-EMA
IgA anti-DGP Ab
IgG Anti-gliadin Ab IgE antibody to wheat protein
Gastroduodenoscopy Scalloping, grooving of duodenal folds Normal Normal
Histology Various grades of villous atrophy with crypt hyperplasia Normal/increased intra-epithelial lymphocytes Normal
Treatment Gluten-free diet Gluten free diet Wheat restriction
Spontaneous resolution No Not known 65% by 12 years of age

NCGS, non-celiac gluten sensitivity; F, female; M, male; Ab, antibody; tTG, tissue transglutaminase; EMA, endomysial antibody; DGP, deamidated gliadin peptide; FODMAP, fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.

J Neurogastroenterol Motil 2021;27:337~346
© J Neurogastroenterol Motil