Nonceliac Wheat Sensitivity: Bridging Research, Clinical Experience, Uncertainties, and Future Perspective.

Antonio Carroccio, Kamran Rostami, Alessio Fasano, Alessandra Giuliano, Carlo Catassi

Journal: Gastrointestinal endoscopy clinics of North America 2025;35(4):893-909

PMID: 41107020

Abstract

Nonceliac wheat sensitivity is a recently characterized disorder. Pathogenesis is still unclear, but it is known that not only gluten but also other wheat components, such as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols and amylase-trypsin inhibitors, could activate patient's immunity and cause the onset of symptoms. This review illustrates the progress made over the last few decades and clinical/histologic features, as well as controversies. The lack of a biomarker makes the diagnosis still difficult. It is currently a diagnosis of exclusion, confirmed by a double-blind challenge with wheat. Further studies are needed to improve the diagnostic and therapeutic approach to this disease.

Address: Unit of Internal Medicine, "V. Cervello" Hospital, Ospedali Riuniti "Villa Sofia-Cervello", via Trabucco, Palermo, 90100, Italy; Unit of Internal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, via del Vespro 141, Palermo, 90100, Italy.; Department of Gastroenterology, Palmerston North District Health Board (DHB), Palmerston North, New Zealand.; Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA, USA.; Unit of Internal Medicine, "V. Cervello" Hospital, Ospedali Riuniti "Villa Sofia-Cervello", via Trabucco, Palermo, 90100, Italy.; Department of Pediatrics, Polytechnic University of Marche, "G. Salesi" Children's Hospital, via F. Corridoni 11, Ancona I-60123, Italy. Electronic address: [email protected].

DOI: 10.1016/j.giec.2025.02.010

MeSH Terms: Humans, Wheat Hypersensitivity, Triticum, Glutens