Celiac disease or gluten sensitivity? The difference isn’t always easy to identify when specific symptoms appear after consuming foods containing wheat proteins, gluten, or wheat in general, largely due to a lack of clear diagnostic criteria. However, one in ten people worldwide report gastrointestinal or systemic disturbances, even without a confirmed diagnosis of celiac disease or wheat allergy. This is what a wide systematic review and meta-analysis published in Gut suggests.
A Condition Still to Be Clarified
Non-celiac gluten/wheat sensitivity (NCGWS) generally identifies a broad spectrum of gastrointestinal and extraintestinal symptoms triggered by the ingestion of gluten or wheat in people without celiac disease or wheat allergy. Symptoms typically improve when foods and substances containing these ingredients are avoided, but reappear after new exposure. Self-reported NCGWS is a global phenomenon that has drawn broader attention over the past decade, but remains difficult to evaluate and recognize due to the absence of specific biological markers. All of these factors prevent definitive global estimates of overall NCGWS prevalence, as well as a clear synthesis of its clinical features and associated factors.
The Added Value of the Meta-Analysis
This study overcomes an early limitation/critical gap that has persisted in NCGWS: it provides, in fact, the first comprehensive global synthesis that is methodologically solid of the prevalence and clinical characteristics of self-reported gluten/wheat sensitivity, leading to the estimate that roughly 10% of people worldwide report symptoms related to these ingredients and substances, despite not suffering from celiac disease or wheat allergy.
Moreover, the study enables characterization of NCGWS in terms of gender and manifestations. This condition would affect women more significantly (OR 2.29), with symptoms linked to anxiety (OR 2.95), depression (OR 2.42), and irritable bowel syndrome (IBS) (OR 4.78), not surprisingly all manifestations to which women are generally more exposed.
Additionally, the study reveals that about 40% of people with self-reported NCGWS follow a gluten-free diet, often self-managed and not advised by a clinician, to alleviate the noted symptoms. These initial findings appear robust; they are based on a systematic review of 25 studies conducted between 2014 and 2024, encompassing more than 49,470 participants from 16 countries. They indicate, across the entire population—one in ten—that identify with this sensitivity, even without a confirmed diagnosis of celiac disease and/or gluten intolerance, a substantial geographic variation ranging from 0.7% in Chile to 23% in the United Kingdom and up to 36% in Saudi Arabia.
The lack of clear diagnostic criteria and the overlap with other gastrointestinal disorders still make it challenging to distinguish true cases from other eating- or stress-related conditions, impacting the ability to gauge over- or underestimation of NCGWS. Hence the call for new studies.
The Proposal
Based on the evidence emerging, experts recommend recognizing NCGWS as part of the so-called “gut-brain axis disorders,” a group that also includes irritable bowel syndrome and arises from a complex interaction among the nervous system, the microbiome, and psychological factors.
This would allow personalized management of NCGWS, tailored to symptoms rather than solely eliminating gluten, thereby avoiding unnecessary dietary restrictions. Additional studies will be needed to identify new clinical and diagnostic criteria useful for distinguishing NCGWS from other functional gastrointestinal disorders and reducing the risk of self-diagnosis and DIY diets. The substantial variability in data across countries could reflect cultural, dietary, or methodological differences, or varying individual perceptions of diet-related well-being.
Source
Shiha MG, Manza F, Figueroa-Salcido OG et al. Global prevalence of self-reported non-coeliac gluten and wheat sensitivity: a systematic review and meta-analysis. Gut, 2025. Doi: https://doi.org/10.1136/gutjnl-2025-336304
Abbonati a Karla Miller
