No celiac disease? You could still be gluten-sensitive

Gluten sensitivity is characterised by both intestinal and extra-intestinal symptoms, with an early onset after gluten ingestion, a rapid relief after gluten withdrawal, and an immediate relapse after gluten challenge. Symptoms appear or disappear within hours or days after the ingestion or elimination of gluten from the diet.

The picture is usually a combination of irritable bowel syndrome (IBS)-like symptoms including stomach ache, bloating, diarrhoea, constipation, hyperacidity and other non-gastrointestinal symptoms such as fatigue, lethargy, “foggy mind”, attention deficit, headache, joint and muscle pain, cramps, imbalance, dermatitis (eczema, skin rash or psoriasis), mouth ulcers, irritability, depression, bipolar disorder, anaemia, stuffiness and even sinusitis.

Gluten sensitivity is considered by many as a subtype of IBS, as the clinical picture is almost always dominated by IBS-type symptoms. However, it must be differentiated from IBS, because it is characterised by extra-intestinal symptoms which are not usually observed in patients with IBS.

A number of people without wheat allergy and celiac disease complain of gluten-induced symptoms. But for many years, they have not been acknowledged by physicians and experts. Diagnosis can often be overlooked and many patients may go through rounds of hospital admissions due to debility and ill health, and can even be put on anti-tubercular treatment for unexplained diarrhoea — which only worsens their condition. At times, many of them are also addressed to psychiatric clinics after a diagnosis of mental illness.

According to estimates, gluten sensitivity is six times more prevalent than celiac disease. Interestingly, gluten sensitivity runs in families and is commonly present is relatives and family members of an individual with celiac disease.

Gluten sensitivity has been recognised as less severe than celiac disease. However, the treatment must not be started without ruling out celiac disease.