Disorders caused by dietary gluten

Donedavno su celijakija i alergija na pšenicu bile jedine bolesti koje su se povezivale s glutenom. No, rastući problem s kojim se kliničari susreću u svome radu su pacijenti koji se žale na simptome povezane s prehrambenim proizvodima koji sadrže gluten, ali koji nemaju pozitivne dijagnostičke markere za celijakiju, poput tipičnog histološkog nalaza biopsije tankoga crijeva i pozitivnih seroloških nalaza, te alergološke testove za dijagnozu alergije na pšenicu. Stoga je predložen novi klinički entitet, ne-celijakična preosjetljivost na gluten, te klasifikacija svih poremećaja izazvanih glutenom. Ova podjela dijeli poremećaje izazvane glutenom prema imunopatogenezi u tri oblika: autoimuni (celijakija, herpetiformni dermatitis i glutenska ataksija), alergijski (alergija na pšenicu) i vjerojatno imunološki posredovani (ne-celijakična preosjetljivost na gluten). Klinička slika ne-celijakične preosjetljivosti na gluten se očituje raznim gastrointestinalnim i ekstraintestinalnim simptomima koji su vrlo slični simptomima celijakije i alergije na pšenicu što može otežati postavljanje dijagnoze. Također, zasada nisu otkriveni biomarkeri specifični za ne-celijakičnu preosjetljivost na gluten te se stoga dijagnoza temelji na isključenju celijakije i alergije na pšenicu. Svim poremećajima je zajednička povezanost između ingestije glutena i nastupa simptoma te poboljšanje tegoba nakon isključenja glutena iz prehrane. Stoga je bezglutenska prehrana zajednička terapija svih poremećaja izazvanih glutenom. No, prije uvođenja ove prehrane svakako treba postaviti ispravnu dijagnozu. Tijek i težina ovih poremećaja, kao i njihove posljedice, su vrlo različiti te je točna dijagnoza od izrazite važnosti, a uvođenje bezglutenske prehrane prije postavljanja konačne dijagnoze može dovesti do lažno negativnih nalaza i posljedično do krive dijagnoze.Until recently, celiac disease and wheat allergy where the only conditions associated with gluten. However, patients who complain of symptoms associated with the ingestion of gluten-containing products have been a growing problem in clinical practice, though they lack diagnostic markers for celiac disease, such as negative celiac serology and normal duodenal biopsies, and negative allergy tests for wheat allergy. Therefore, a new clinical term, non-celiac gluten sensitivity, and classification of gluten-related disorders have been proposed. This classification divides glutenrelated disorders into three categories according to their immunopathogenesis: autoimmune (celiac disease, dermatitis herpetiformis and gluten ataxia), allergic (wheat allergy) and probably immune-mediated (non-celiac gluten sensitivity). Clinical manifestation of non-celiac gluten sensitivity includes various gastrointestinal and extraintestinal symptoms which are very similar to those of celiac disease and wheat allergy making their differential diagnosis challenging. In addition, specific biomarkers for non-celiac gluten sensitivity have not yet been discovered, therefore the diagnosis of this disorder is based on the exclusion of celiac disease and wheat allergy. There is a common correlation between gluten ingestion and onset of symptoms in these disorders, as well as symptom improvement after the exclusion of gluten from diet. Thus, gluten-free diet is a common therapy for all gluten-related disorders. However, an accurate diagnosis is certainly needed before the introduction of gluten-free diet. Progress of these disorders and their severity, as well as complications, are very different, so proper diagnosis is of crucial interest. Furthermore, the introduction of gluten-free diet before making a correct diagnosis can lead to false negative results and, consequently, inaccurate diagnosis