From Ptolemaus to Copernicus: The Evolving System of Gluten-Related Disorder

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Gluten is the major protein of wheat and other cereals (rye and barley); it is responsible for triggering celiac disease (CD) in genetically predisposed individuals. Until a few years ago, CD was the major (if not the only) well-known gluten-related disorder. However, in recent years, it has become clear that gluten proteins may activate different pathological mechanisms, leading to a wide spectrum of human diseases, including non-celiac gluten sensitivity (NCGS), gluten ataxia, neuro-psychiatric disorders, and many others. Conceptually, we have therefore moved from a Ptolemaic to a Copernican system, i.e., CD is no longer the center of the universe , but is just one of the possible worlds of gluten intolerance. Many other gluten planets do indeed exist and deserve the attention of researchers and clinicians alike.
Although different gluten-related disorders show specific epidemiological, pathophysiological, and clinical aspects, these conditions share a trigger and treatment: the gluten-free diet. For a very long time, awareness of these disorders has been limited and, therefore, the epidemiology of gluten-related disorders is still a work in progress . Current research strives to clarify the boundaries between these entities, their disease mechanisms, and how a proper diagnosis can be implemented.