Gluten-related conditions and how doctors tell them apart
What it found
Celiac disease and nonceliac gluten sensitivity are common, and both are treated with a gluten-free diet.
Doctors cannot tell them apart from symptoms alone, so testing for celiac disease must happen before a gluten-free diet starts.
What they found
Studies in people
Symptoms can be widespread
Even though the inflammation targets the gut lining, people may have gut symptoms, symptoms elsewhere in the body, or both. This suggests celiac disease affects the whole body.
Nonceliac gluten sensitivity
This is diagnosed in people who do not have celiac disease or wheat allergy but get gut symptoms, other symptoms, or both when they eat gluten-containing grains, and improve when they stop.
Symptoms look the same
Doctors cannot tell celiac disease and nonceliac gluten sensitivity apart by symptoms, because the symptoms are similar in both.
Other findings
What celiac disease is
Celiac disease is an immune reaction triggered by gluten. It is marked by specific genes (HLA-DQ2 and HLA-DQ8) and certain autoantibodies, and it targets the lining of the gut.
Hard to pin down
Symptoms vary and there are no validated biomarkers for nonceliac gluten sensitivity. This makes it hard to work out how common it is, to diagnose it, and to study it further.
Test before going gluten-free
Screening for celiac disease must be done before a gluten-free diet is started. Once a person begins the diet, testing for celiac disease is no longer accurate.
What the authors conclude
“Clinicians cannot distinguish between celiac disease and nonceliac gluten sensitivity by symptoms, as they are similar in both.”
Also in their conclusions
- They say celiac disease and nonceliac gluten sensitivity are common.
- They say that although both are treated with a gluten-free diet, telling them apart matters for long-term therapy.
- They advise that patients with celiac disease should be followed up closely for dietary adherence, nutritional deficiencies, and the development of possible other conditions.
How it was done
More people are trying a gluten-free diet on their own for various signs and symptoms, and the number of gluten-related disorders is rising. The authors wanted to lay out the current evidence on screening, diagnosis and treatment.
What it can’t tell you
- We summarised it from the abstract only.
- This is a review of existing evidence, not a new study, so it cannot prove what causes these conditions.
- It cannot say how common nonceliac gluten sensitivity is, because there are no validated biomarkers for it.
- It cannot show whether a gluten-free diet helps people who do not have celiac disease or wheat allergy.
Who paid
- Funding
- Funded by NIDDK NIH HHS (from the PubMed record).
- Authors work at
- MassGeneral Hospital for Children, Massachusetts; Harvard Medical School, Massachusetts; European Biomedical Research Institute Salerno, Italy
The paper
- Title
- Celiac Disease and Nonceliac Gluten Sensitivity: A Review
- Type
- ReviewThe authors read earlier studies and describe what they found. It isn’t a new study.
- Evidence
- Studies in people
- Summarised from
- Abstract only
- Cite
- Leonard MM, Sapone A, Catassi C, Fasano A (2017). Celiac Disease and Nonceliac Gluten Sensitivity: A Review. JAMA. doi:10.1001/jama.2017.9730PubMed 28810029DOI
Summary written 26 Sep 2026. Check it against the paper before it changes what you eat. How we summarise papers · Report an error