title: Diagnosis of gluten related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity.
abstract: Cereal crops and cereal consumption have had a vital role in Mankind's history. In the recent years gluten ingestion has been linked with a range of clinical disorders. Gluten-related disorders have gradually emerged as an epidemiologically relevant phenomenon with an estimated global prevalence around 5%. Celiac disease, wheat allergy and non-celiac gluten sensitivity represent different gluten-related disorders. Similar clinical manifestations can be observed in these disorders, yet there are peculiar pathogenetic pathways involved in their development. Celiac disease and wheat allergy have been extensively studied, while non-celiac gluten sensitivity is a relatively novel clinical entity, believed to be closely related to other gastrointestinal functional syndromes. The diagnosis of celiac disease and wheat allergy is based on a combination of findings from the patient's clinical history and specific tests, including serology and duodenal biopsies in case of celiac disease, or laboratory and functional assays for wheat allergy. On the other hand, non-celiac gluten sensitivity is still mainly a diagnosis of exclusion, in the absence of clear-cut diagnostic criteria. A multimodal pragmatic approach combining findings from the clinical history, symptoms, serological and histological tests is required in order to reach an accurate diagnosis. A thorough knowledge of the differences and overlap in clinical presentation among gluten-related disorders, and between them and other gastrointestinal disorders, will help clinicians in the process of differential diagnosis.
authors.affiliation: Luca Elli, Federica Branchi, Carolina Tomba, Lorenzo Norsa, Francesca Ferretti, Leda Roncoroni, Maria Teresa Bardella, Center for the Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Elli
authors.affiliation: Luca Elli, Federica Branchi, Carolina Tomba, Lorenzo Norsa, Francesca Ferretti, Leda Roncoroni, Maria Teresa Bardella, Center for the Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Branchi
authors.affiliation: Luca Elli, Federica Branchi, Carolina Tomba, Lorenzo Norsa, Francesca Ferretti, Leda Roncoroni, Maria Teresa Bardella, Center for the Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
authors.forename: Carolina
authors.initials: C
authors.lastname: Tomba
authors.affiliation: Luca Elli, Federica Branchi, Carolina Tomba, Lorenzo Norsa, Francesca Ferretti, Leda Roncoroni, Maria Teresa Bardella, Center for the Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
authors.forename: Danilo
authors.initials: D
authors.lastname: Villalta
authors.affiliation: Luca Elli, Federica Branchi, Carolina Tomba, Lorenzo Norsa, Francesca Ferretti, Leda Roncoroni, Maria Teresa Bardella, Center for the Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Norsa
authors.affiliation: Luca Elli, Federica Branchi, Carolina Tomba, Lorenzo Norsa, Francesca Ferretti, Leda Roncoroni, Maria Teresa Bardella, Center for the Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ferretti
authors.affiliation: Luca Elli, Federica Branchi, Carolina Tomba, Lorenzo Norsa, Francesca Ferretti, Leda Roncoroni, Maria Teresa Bardella, Center for the Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
authors.forename: Leda
authors.initials: L
authors.lastname: Roncoroni
authors.affiliation: Luca Elli, Federica Branchi, Carolina Tomba, Lorenzo Norsa, Francesca Ferretti, Leda Roncoroni, Maria Teresa Bardella, Center for the Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Bardella
mesh_terms: D000328:Adult; D017668:Age of Onset; D002446:Celiac Disease / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003938:Diagnostic Techniques, Digestive System; D005512:Food Hypersensitivity / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology / Q000628:therapy; D005983:Glutens / Q000009:adverse effects*; D006801:Humans; D007159:Immunologic Tests; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D021182:Wheat Hypersensitivity / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology / Q000628:therapy
chemical_list: D005983:Glutens
keywords: Allergy; Celiac disease; Gluten sensitivity; Gluten-free diet; Wheat sensitivity