Document Detail


Celiac disease or non-celiac gluten sensitivity? An approach to clinical differential diagnosis.
MedLine Citation:
PMID:  24619056     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 >2× 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.
Authors:
Toufic A Kabbani; Rohini R Vanga; Daniel A Leffler; Javier Villafuerte-Galvez; Kumar Pallav; Joshua Hansen; Rupa Mukherjee; Melinda Dennis; Ciaran P Kelly
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2014-03-11
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  109     ISSN:  1572-0241     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2014 May 
Date Detail:
Created Date:  2014-05-06     Completed Date:  2014-06-23     Revised Date:  2014-10-21    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  741-6; quiz 747     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Algorithms
Biological Markers / blood
Celiac Disease / blood,  diagnosis*,  diet therapy
Decision Support Techniques*
Diagnosis, Differential
Diet, Gluten-Free
Female
Food Hypersensitivity / blood,  diagnosis*,  diet therapy
Glutens / adverse effects*
HLA-DQ Antigens / blood
Humans
Likelihood Functions
Male
Models, Theoretical
Retrospective Studies
Chemical
Reg. No./Substance:
0/Biological Markers; 0/HLA-DQ Antigens; 0/HLA-DQ2 antigen; 0/HLA-DQ8 antigen; 8002-80-0/Glutens
Comments/Corrections
Comment In:
Am J Gastroenterol. 2014 Jul;109(7):1085-6   [PMID:  24989102 ]
Am J Gastroenterol. 2014 Sep;109(9):1498-9   [PMID:  25196880 ]
Am J Gastroenterol. 2014 Sep;109(9):1499-500   [PMID:  25196881 ]

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