A 36-Year-Old Woman With Flatulence and Memory Problems

Alexander Potashinsky, MD; John W. Birk, MD


April 19, 2022

In the age of food fads and needless gluten avoidance, clinicians still need to recognize NCGS. A high degree of suspicion should be present in patients who are believed to have IBS but who demonstrate extraintestinal symptoms, as well as patients who have features of celiac disease but negative serologic testing results. Active research is being done to determine the exact pathophysiology of NCGS and to determine markers of disease that would enable more definitive testing.

Besides a gluten-free diet, further treatment options for NCGS are currently under investigation. These include use of probiotics for alleviation of NCGS-related symptoms while maintaining a gluten-free diet and reintroduction of gluten in a controlled environment. This is intended to resolve gut dysbiosis by reintroducing gut flora, reducing both gut and systemic inflammation.[5] The enzyme Aspergillus niger prolyl endoprotease (AN-PEP) has been reported to significantly enhance gluten digestion in the stomach of healthy individuals. Thus, it could be considered another treatment option for these patients by means of degrading gluten before it affects the human gut, allowing individuals to enjoy food without dietary restrictions, worrisome symptoms, or soaring food costs.[5]

The patient in this case had already initiated her own treatment by starting a gluten-free diet. After other common causes of her symptoms, such as uncontrolled thyroid disease and celiac disease, were ruled out, she was evaluated with a simplified food challenge for NCGS. She was asked to use gluten-containing bread, which led to a relapse of symptoms, and then gluten-free bread, which led to resolution of symptoms. Given this high degree of correlation, she was diagnosed with NCGS and was relieved to find out the cause of her problems. One year after starting a strict gluten-free diet, she remains mostly symptom-free.


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