Celiac disease vs. gluten sensitivity: two different realities

Celiac disease affects about 1% of the world's population, but 80% of cases are undiagnosed. It is often confused with non-celiac gluten sensitivity, which is a distinct clinical entity.

Celiac disease

• Mechanism: autoimmune reaction triggered by gluten (wheat, barley, rye) that destroys intestinal villi
• Diagnosis: anti-transglutaminase IgA antibodies + duodenal biopsy
• Consequences if untreated: malabsorption, anemia, osteoporosis, intestinal lymphoma, infertility
• Treatment : STRICT gluten-free diet for life (even traces are harmful)

Non-celiac gluten sensitivity

• Mechanism: poorly understood, no villous destruction or autoantibodies
• Diagnosis: exclusion of celiac disease and wheat allergy
• Symptoms: digestive and extra-digestive (fatigue, brain fog, joint pain)
• Treatment: less strict gluten-free diet, traces are generally tolerated

Important points

• NEVER start a gluten-free diet before diagnosis (it skews results)
• A gluten-free diet without medical reason has no proven health benefits
• Celiac disease has a genetic component (HLA-DQ2/DQ8)