Non-celiac gluten sensitivity not yet universally adopted. For people on a gluten-free diet who are unable to perform an oral gluten challenge, an alternative to identify possible celiac disease is an in vitro gliadin challenge of small bowel biopsies; this test is only available at selected specialized tertiary-care centers. After exclusion of celiac disease and wheat allergy, the subsequent step for diagnosis and treatment of NCGS is to start a strict gluten-free diet (GFD) to assess if symptoms improve or resolve completely. This may occur within days to weeks of starting a GFD, but improvement may also be due to a non-specific, placebo
Gluten diet and a self-diagnosis of gluten sensitivity. People with NCGS may develop gastrointestinal symptoms, which resemble those of irritable bowel syndrome or wheat allergy, or a wide variety of non-gastrointestinal symptoms, such as headache, chronic fatigue, fibromyalgia, atopic diseases, allergies, neurological diseases, or psychiatric disorders, among others. Besides gluten, additional components present in wheat, rye, barley, oats, and their derivatives, including other proteins called ATIs and short-chain carbohydrates known as FODMAPs, may cause NCGS symptoms. The effects of FODMAPs are only limited to gastrointestinal mild discomfort. ATIs may cause toll-like receptor 4 (TLR4)-mediated intestinal inflammation in humans. People can also