Controversies and challenges in non-celiac gluten/wheat sensitivity

Non-celiac gluten sensitivity (NCGS) has emerged as an intriguing and controversial topic in gastroenterology since the first reports over 40 years ago. The most recent definition requires a symptomatic reaction to gluten, or wheat containing food, the remission of symptoms with gluten or wheat challenge, and the exclusion of both celiac disease and wheat allergy. A definitive diagnosis of NCGS is challenging as there are no specific tests or biomarkers, and we still question the exact trigger for the condition. There have been several studies, including randomized-controlled trials (RCT), that aimed to understand whether it is gluten or the carbohydrate fraction in wheat, that trigger symptoms in non-celiac patients. Here, we review the literature to address outstanding controversies and challenges related to the diagnosis and management of this condition, as well as areas of interest for future studies.