Gluteenitalumatuste

Gluteenitalumatuste is a term used to describe a spectrum of disorders characterized by intolerance to dietary gluten. It encompasses autoimmune celiac disease and non-celiac gluten sensitivity, and it is distinct from wheat allergy, which is an IgE-mediated reaction to wheat proteins.

Symptoms typically affect the digestive tract but can be broader. Common gastrointestinal signs include abdominal pain, bloating, diarrhea, constipation, and weight changes. Extraintestinal symptoms may include fatigue, anemia, iron deficiency, joint or bone pain, skin rashes such as dermatitis herpetiformis, and in some individuals, neurological or mood-related symptoms. The magnitude and combination of symptoms vary between individuals and across ages.

Pathophysiology varies within the spectrum. Celiac disease involves an autoimmune response to gluten in genetically predisposed individuals, often linked to HLA-DQ2 or HLA-DQ8, leading to small intestinal villous atrophy and malabsorption. Non-celiac gluten sensitivity is diagnosed when gluten-related symptoms occur without the serologic or histologic findings of celiac disease and without wheat allergy, though the underlying mechanisms are not fully understood and may involve innate immune or other pathways. Both conditions require careful differential diagnosis to exclude other causes of similar symptoms.

Diagnosis typically starts with clinical evaluation and serologic testing for celiac disease (such as tTG-IgA or EMA) with consideration of total IgA levels, followed by intestinal biopsy if indicated. Wheat allergy is assessed with skin prick tests or specific IgE testing. A diagnosis of non-celiac gluten sensitivity is generally made by excluding celiac disease and wheat allergy and observing symptom improvement on a gluten-free diet, sometimes followed by a gluten challenge.

Management centers on a strict, lifelong gluten-free diet, careful reading of labels, and attention to nutritional balance. Regular follow-up supports monitoring of symptom resolution, growth in children, and potential nutrient deficiencies or inadvertent gluten exposure.