PMID- 24619056
OWN - NLM
STAT- MEDLINE
DCOM- 20140623
LR  - 20191210
IS  - 1572-0241 (Electronic)
IS  - 0002-9270 (Linking)
VI  - 109
IP  - 5
DP  - 2014 May
TI  - Celiac disease or non-celiac gluten sensitivity? An approach to clinical 
      differential diagnosis.
PG  - 741-6; quiz 747
LID - 10.1038/ajg.2014.41 [doi]
AB  - OBJECTIVES: Differentiating between celiac disease (CD) and non-celiac gluten 
      sensitivity (NCGS) is important for appropriate management but is often 
      challenging. METHODS: We retrospectively reviewed records from 238 patients who 
      presented for the evaluation of symptoms responsive to gluten restriction without 
      prior diagnosis or exclusion of CD. Demographics, presenting symptoms, serologic, 
      genetic, and histologic data, nutrient deficiencies, personal history of 
      autoimmune diseases, and family history of CD were recorded. NCGS was defined as 
      symptoms responsive to a gluten-free diet (GFD) in the setting of negative celiac 
      serology and duodenal biopsies while on a gluten-containing diet or negative 
      human leukocyte antigen (HLA) DQ2/DQ8 testing. RESULTS: Of the 238 study 
      subjects, 101 had CD, 125 had NCGS, 9 had non-celiac enteropathy, and 3 had 
      indeterminate diagnosis. CD subjects presented with symptoms of malabsorption 
      67.3% of the time compared with 24.8% of the NCGS subjects (P<0.0001). In 
      addition, CD subjects were significantly more likely to have a family history of 
      CD (P=0.004), personal history of autoimmune diseases (P=0.002), or nutrient 
      deficiencies (P<0.0001). The positive likelihood ratio for diagnosis of CD of a 
      >2x upper limit of normal IgA trans-glutaminase antibody (tTG) or IgA/IgG 
      deaminated gliadan peptide antibody (DGP) with clinical response to GFD was 130 
      (confidence interval (CI): 18.5-918.3). The positive likelihood ratio of the 
      combination of gluten-responsive symptoms and negative IgA tTG or IgA/IgG DGP on 
      a regular diet for NCGS was 9.6 (CI: 5.5-16.9). When individuals with negative 
      IgA tTG or IgA/IgG DGP also lacked symptoms of malabsorption (weight loss, 
      diarrhea, and nutrient deficiencies) and CD risk factors (personal history of 
      autoimmune diseases and family history of CD), the positive likelihood ratio for 
      NCGS increased to 80.9. CONCLUSIONS: On the basis of our findings, we have 
      developed a diagnostic algorithm to differentiate CD from NCGS. Subjects with 
      negative celiac serologies (IgA tTG or IgA/IgG DGP) on a regular diet are 
      unlikely to have CD. Those with negative serology who also lack clinical evidence 
      of malabsorption and CD risk factors are highly likely to have NCGS and may not 
      require further testing. Those with equivocal serology should undergo HLA typing 
      to determine the need for biopsy.
FAU - Kabbani, Toufic A
AU  - Kabbani TA
AD  - 1] Celiac Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, 
      USA [2] Harvard School of Public Health, Boston, Massachusetts, USA.
FAU - Vanga, Rohini R
AU  - Vanga RR
AD  - Celiac Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
FAU - Leffler, Daniel A
AU  - Leffler DA
AD  - Celiac Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
FAU - Villafuerte-Galvez, Javier
AU  - Villafuerte-Galvez J
AD  - Celiac Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
FAU - Pallav, Kumar
AU  - Pallav K
AD  - Celiac Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
FAU - Hansen, Joshua
AU  - Hansen J
AD  - Celiac Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
FAU - Mukherjee, Rupa
AU  - Mukherjee R
AD  - Celiac Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
FAU - Dennis, Melinda
AU  - Dennis M
AD  - Celiac Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
FAU - Kelly, Ciaran P
AU  - Kelly CP
AD  - Celiac Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
DEP - 20140311
PL  - United States
TA  - Am J Gastroenterol
JT  - The American journal of gastroenterology
JID - 0421030
RN  - 0 (Biomarkers)
RN  - 0 (HLA-DQ Antigens)
RN  - 0 (HLA-DQ2 antigen)
RN  - 0 (HLA-DQ8 antigen)
RN  - 8002-80-0 (Glutens)
SB  - IM
CIN - Am J Gastroenterol. 2014 Jul;109(7):1085-6. PMID: 24989102
CIN - Am J Gastroenterol. 2014 Sep;109(9):1498-9. PMID: 25196880
CIN - Am J Gastroenterol. 2014 Sep;109(9):1499-500. PMID: 25196881
MH  - Adult
MH  - Algorithms
MH  - Biomarkers/blood
MH  - Celiac Disease/blood/*diagnosis/diet therapy
MH  - *Decision Support Techniques
MH  - Diagnosis, Differential
MH  - Diet, Gluten-Free
MH  - Female
MH  - Food Hypersensitivity/blood/*diagnosis/diet therapy
MH  - Glutens/*adverse effects
MH  - HLA-DQ Antigens/blood
MH  - Humans
MH  - Likelihood Functions
MH  - Male
MH  - Models, Theoretical
MH  - Retrospective Studies
EDAT- 2014/03/13 06:00
MHDA- 2014/06/24 06:00
CRDT- 2014/03/13 06:00
PHST- 2013/07/11 00:00 [received]
PHST- 2014/01/14 00:00 [accepted]
PHST- 2014/03/13 06:00 [entrez]
PHST- 2014/03/13 06:00 [pubmed]
PHST- 2014/06/24 06:00 [medline]
AID - ajg201441 [pii]
AID - 10.1038/ajg.2014.41 [doi]
PST - ppublish
SO  - Am J Gastroenterol. 2014 May;109(5):741-6; quiz 747. doi: 10.1038/ajg.2014.41. 
      Epub 2014 Mar 11.