The Overlap of Irritable Bowel Syndrome and Noncoeliac Gluten Sensitivity

Anupam Rej; David S. Sanders


Curr Opin Gastroenterol. 2019;35(3):199-205. 

In This Article


NCGS appears to part of a spectrum of gluten-related disorders. These also include coeliac disease, potential coeliac disease and IBS, as seen in Figure 1. The prevalence of NCGS is variable, being reported between 0.6 and 10.6% in the literature.[2,7–14] This large variability in reported prevalence rate may in part be explained by a lack of specific biomarkers for the diagnosis of NCGS. In terms of potential biomarkers, antigliadin antibodies (AGAs) have been noted in approximately 50% of individuals with NCGS.[15,16] However, it is important to note that the studies, which have reported this have been uncontrolled. Individuals with NCGS and IBS were reviewed with no healthy comparators. Therefore, the benefit of AGAs as a biomarker in NCGS is unclear.

Figure 1.

The spectrum of gluten-related disorders. EMA, endomysial antibodies; GFD, gluten-free diet; IBS, irritable bowel syndrome; LFD, low fermentable oligosaccharides, disaccharides, and monosaccharides, and polyols diet; TTG, tissue transglutaminase; WFD, wheat-free diet. Reproduced with permission from [55].

The variable-reported prevalence for NCGS can also be explained by the large overlap in symptoms between both NCGS and IBS. This was demonstrated in a large UK population-based questionnaire (n = 1002), where a large proportion of individuals with self-reported gluten sensitivity fulfilled the Rome III criteria for IBS in comparison with those without (20 versus 3.89%, P < 0.0001).[10] The reported prevalence of IBS is similar to NCGS, with a reported global pooled prevalence of 11%.[17] Both of these conditions predominantly affect female population and young/middle aged adults.[5,17]