Different Processes Involved in Celiac Disease and Gluten Sensitivity
Gluten sensitivity is a completely different condition from celiac disease (CD) and the vast majority of people who suffer from gluten sensitivity (also called gluten intolerance) will never develop CD, reports Dr. Fasano.
However, there is no doubt that gluten sensitivity is a real condition and potentially affects more than 1 in 20 people, Dr. Fasano reports in an interview. He and his colleagues at the University of Maryland Celiac Research Center recently published a study proving for the first time that gluten sensitivity exists.
“We’re talking about 20 million people,” he says. “This gives us some rational reasons why so many people come to us with symptoms.”
People with CD have specific gut damage caused by an autoimmune reaction to ingested gluten. People with gluten sensitivity don’t have this damage, although they do experience inflammation from gluten, says Dr. Fasano.
The difference between these two conditions comes from the immune system’s response to gluten.
In gluten sensitivity, the innate immune system — the body’s first line of defense against invaders — responds to gluten ingestion by directly fighting the gluten, creating inflammation both inside and out. outside of the digestive system, says Dr. Fasano.
In CD, both the innate immune system and the adaptive immune system — a more advanced and sophisticated part of the immune system — are involved in the battle, he says. Miscommunication between cells of the adaptive immune system leads these cells to attack the body’s own tissues, creating the villous atrophy found in celiacs.
A few people identified as gluten sensitive in the study conducted at the University of Maryland showed intestinal damage. However, this damage had different biomarkers than those found in CD, and people with gluten sensitivity are unlikely to develop CD, says Dr. Fasano.
There’s no doubt that gluten-sensitive people and celiacs can often experience the same symptoms including diarrhea, bloating, abdominal pain, depression, difficulty concentrating and migraines, reports Fasano.
Only people with an adaptive immune response unique to CD are at risk of developing intestinal lymphoma and other CD-associated conditions like osteoporosis, he says. However, gluten sensitivity appears to play a role in 20% of autism and schizophrenia cases, he says.
Dr. Fasano added that he first became interested in exploring the possibility of gluten sensitivity two or three years ago. Before, he says, I told my patients who tested negative for celiac disease (CD) that gluten was not their problem, even if those people were convinced that gluten was the cause of their symptoms.
“In the past two years, we’ve been inundated with people coming to the clinic believing they have CD; the vast majority don’t have it,” he says. “What this study provides is evidence at the molecular level that gluten sensitivity exists.”
Dr. Fasano says that research on gluten sensitivity is in its infancy and further studies will be needed to better understand this condition and to be able to tell the difference between gluten sensitive people and people with gluten sensitivity. MC in its initial phase.
The University of Maryland study identified certain biomarkers that may be helpful in diagnosing gluten sensitivity. However, the method used by researchers to retrieve these biomarkers (endoscopy with intestinal biopsies) is not a practical way to diagnose gluten sensitivity in 6% of the population, says Dr. Fasano.
The next step will therefore be to create blood tests capable of easily detecting gluten sensitivity. Dr. Fasano anticipates that such tests will be available within a few years.