PMID- 35774680
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220716
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 14
IP  - 5
DP  - 2022 May
TI  - Diagnostic Dilemma, Possible Non-celiac Gluten Sensitivity: Consideration in 
      Approach and Management.
PG  - e25302
LID - 10.7759/cureus.25302 [doi]
LID - e25302
AB  - Non-celiac gluten sensitivity (NCGS) is clinically identified as a condition 
      where a percentage of the population reports intestinal and/or extraintestinal 
      symptoms caused by gluten and/or wheat ingestion, and they are tested negative 
      for celiac disease (CD) on the basis of specific serology and histopathology. 
      NCGS should be labelled after the exclusion of CD and wheat allergy. This 
      population reports improved symptoms on a gluten-free diet. Despite great 
      interest and work on NCGS, much remains unknown about its pathogenesis. A 
      positive and improved response to a gluten-free diet for a limited period of time 
      (e.g., six to eight weeks), followed by retrieval of symptoms in case of gluten 
      intake, is presently considered to be the best strategy for confirmation of 
      diagnosis. A middle-aged lady came for medical attention with concerns of weight 
      loss, lethargy and abdominal discomfort. On investigations, her serum 
      transglutaminase IgA was found to be largely raised. The patient was switched to 
      a gluten-free diet with suspicion of CD. Upper GI endoscopy was done one week 
      after being on a gluten-free diet. Both endoscopy with histopathology was 
      negative for villous atrophy and increased intraepithelial lymphocytes. Later 
      human leukocyte antigen (HLA) testing was found to be negative for CD, leading to 
      a diagnostic conundrum. On the basis of remarkable symptom improvement on a 
      gluten-free diet, drop in transglutaminase levels, negative biopsy and HLA 
      testing, the diagnosis was made as possible NCGS. Considering gluten-related 
      disorders are rising and not much is known about NCGS, we aimed to present this 
      case to create awareness and raise questions regarding diagnosis, need for 
      specific monitoring and implications on the management.
CI  - Copyright (c) 2022, Siddiqui et al.
FAU - Siddiqui, Uzma Nasim
AU  - Siddiqui UN
AD  - General Medicine, Port Macquarie Base Hospital, Port Macquarie, AUS.
AD  - General Medicine, Shaikh Zayed Federal Postgraduate Medical Institute, Lahore, 
      PAK.
FAU - Pervaiz, Aima
AU  - Pervaiz A
AD  - Pediatric Medicine, Indus Hospital, Lahore, PAK.
FAU - Khan, Zainab Bashir
AU  - Khan ZB
AD  - Internal Medicine, Shaikh Zayed Federal Postgraduate Medical Institute, Lahore, 
      PAK.
FAU - Sultana, Tabassum
AU  - Sultana T
AD  - Pediatrics and Child Health, Baqai Medical University, Karachi, PAK.
LA  - eng
PT  - Case Reports
DEP - 20220524
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC9236635
OTO - NOTNLM
OT  - approach
OT  - celiac disease
OT  - dilemma
OT  - non celiac gluten sensitivity
OT  - possible diagnosis
COIS- The authors have declared that no competing interests exist.
EDAT- 2022/07/02 06:00
MHDA- 2022/07/02 06:01
PMCR- 2022/05/24
CRDT- 2022/07/01 02:41
PHST- 2022/05/23 00:00 [accepted]
PHST- 2022/07/01 02:41 [entrez]
PHST- 2022/07/02 06:00 [pubmed]
PHST- 2022/07/02 06:01 [medline]
PHST- 2022/05/24 00:00 [pmc-release]
AID - 10.7759/cureus.25302 [doi]
PST - epublish
SO  - Cureus. 2022 May 24;14(5):e25302. doi: 10.7759/cureus.25302. eCollection 2022 
      May.