University of Maryland Study Identifies Differences Between Celiac Disease and Gluten Sensitivity.
“Exactly as we found throughout the study: gluten sensitivity is real”. These are the words from the University of Maryland Celiac Disease Research Center where researchers said gluten sensitivity is a separate and distinct condition from celiac disease.
The researchers, led by Dr. Alession Fasano, found differences between gluten sensitivity and celiac disease (CD) at the molecular level and in the immune system response.
Dr. Fasano estimates that gluten sensitivity affects 6% of the population compared to 1% for CD.
Normally, to be diagnosed with CD, you must undergo an endoscopy showing villous atrophy or the presence of significant damage to the intestinal mucosa.
However, many people with CD symptoms have little or no intestinal damage. Previously, doctors would have told them that gluten was not the cause of their symptoms, but many of them saw their symptoms disappear by following a gluten-free diet.
This finding led Dr. Fasano and his team to conclude that there may be another condition at play: “gluten sensitivity.” In this study, published online March 9 in BMC Medicine , they investigated the difference between patients diagnosed with celiac disease with intestinal damage classified as Marsh III and people without obvious signs of intestinal damage associated with CD but responding to the gluten diet. .
For this study, we recruited 26 gluten-sensitive patients who were subjected to a gluten challenge for 4 months. To meet the criteria classifying them as gluten sensitive, patients had to have negative serological tests for anti-endomysium IgA (EMA-IgA) and anti-transglutaminase IgA (tTG-IgA) antibodies. They also had to have Marsh 0 or Marsh I classified intestinal mucosa and show improvement in symptoms within a few days on a gluten-free diet.
In addition, 42 patients with CD and 39 subjects (for the control group) with dyspepsia without underlying inflammation were recruited.
For each subject, the researchers determined the level of intestinal permeability (in CD, your intestines become more permeable, allowing protein to enter the bloodstream). They also looked at genetics, particularly gene expression in the small intestine.
They found a difference in intestinal permeability and in the expression of genes regulating the immune response between all groups of subjects, indicating that gluten-sensitive individuals have a different response from those with CD.
The study concludes that research should lead to the development of new screening tests for gluten sensitivity.
Study Summary: Discrepancies in gut permeability and mucosal immunity gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med. 2011 Mar 9;9(1):23
Full version: Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med. 2011 Mar 9;9(1):23