title: Noncoeliac gluten sensitivity: a diagnostic dilemma.
abstract: OBJECTIVE
  Noncoeliac gluten sensitivity (NCGS) has gained attention as an emerging clinical entity. Data regarding the epidemiology, pathogenesis, and management of NCGS are scattered in view of the diagnostic uncertainty surrounding the disorder. We aim to provide a current perspective of NCGS and its associated controversies.
  
  
  RESULTS
  NCGS consists of a spectrum of intestinal and extraintestinal symptoms related to the ingestion of gluten-containing food, yet in the absence of coeliac disease or wheat allergy. To date, no specific biomarker exists for NCGS, thereby leaving the diagnosis to be confirmed by dietary elimination followed by double-blind placebo-controlled gluten-based rechallenges. Unfortunately, this technique is cumbersome, not readily-available in routine clinical practise, and can still leave the diagnosis of NCGS open to debate as to whether the effects demonstrated can be specifically attributed to the gluten-protein per se or rather coexisting nongluten components, such as fermentable carbohydrates and amylase-trypsin inhibitors.
  
  
  CONCLUSIONS
  Physicians are increasingly being posed with the dilemma of patients presenting with self-reported NCGS. However, this appears to be the tip of the iceberg and future studies are in need of delineating which gluten-based component is responsible for each individual patient's complaint.
authors.affiliation: aAcademic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK bGastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy *Federica Branchi and Imran Aziz contributed equally to the writing of this article.
authors.forename: Federica
authors.initials: F
authors.lastname: Branchi
authors.forename: Imran
authors.initials: I
authors.lastname: Aziz
authors.forename: Dario
authors.initials: D
authors.lastname: Conte
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
mesh_terms: D015415:Biomarkers; D002446:Celiac Disease / Q000175:diagnosis; D059026:Diagnostic Self Evaluation; D055050:Diet, Gluten-Free; D005512:Food Hypersensitivity / Q000175:diagnosis*; D005983:Glutens / Q000009:adverse effects*; D006801:Humans
chemical_list: D015415:Biomarkers; D005983:Glutens