Non-celiac gluten sensitivity: All wheat attack is not celiac

Table 1 Comparison of gluten related disorders[34,51-72]

	NCGS	CD	IBS	WA
Colonic manifestations	Diarrhea	Diarrhea	Diarrhea	Diarrhea
	Abdominal pain	Abdominal pain	Abdominal pain	Abdominal pain
	Bloating	Bloating	Bloating	Bloating
	Constipation	Constipation	Constipation	Constipation
	Nausea	Nausea	Mucous Discharge	Nausea
	Vomiting	Vomiting	Dyspepsia	Vomiting
			Early satiety
Extra-colonic manifestations	Headache	Anemia	Major depression	Hives
	Migraine	Osteoporosis	Anxiety	Angioedema
	Foggy mind	Neurological disturbances	Somatoform disorder	Asthma
	Fatigue	Pubertal delay	Fibromyalgia	Cough
	Eczema like rash	Dermatitis herpetiformis	Temporomandibular disorder	Post Nasal Drip
	Myositis	Foggy mind	Dyspareunia	Eczema
	Numbness	Lymphoma
	Psychological changes
Symptom Onset	Hours to Days	Hours to months	Unclear relation to gluten ingestion	Minutes to Hours
Cytomorphology	Small bowel intraepithelial lymphocytosis (Marsh 0-1)	Villous atrophy with crypt hyperplasia	Normal	Normal
Biomarkers	IgG-AGA	IL-17(A)	TNF- α	IgE antibodies to wheat protein
	Zonulin	TCR-γδ IELs	IL-6
	LBP	IgA tTGA	IL-8
	sCD14	IgA EMA
		CD3 + IELS
		Zonulin
Immunophenotype	HLA- DQ2 and DQ8 genotypes in 50% patients	HLA- DQ2 and DQ8 genotypes in 80% patients	Increase in:	Transforming growth factor-b (TGFb) mutations have been associated with higher rates of allergic disease
			B cells expressing IgG or co-stimulatory molecules CD80 or CD86
			T cells expressing b7 + HLADR+ and CD69+
Diagnosis	See figure 2	1Serologic testing followed by small bowel biopsy	Rome III diagnostic criteria	Skin prick test
				Presence of serum IGE antibodies to wheat protein
Management	GFD	GFD	Symptomatic treatment and elimination of stressors	GFD
	Probiotics			Subcutaneous epinephrine for any acute episodes
	AN-PEP
ICD codes	K90.41	K90.0	K58	K52.29

¹4 out of 5 of the following: Typical symptoms of CD, Serum CD IgA class auto antibodies at high titer, HLA-DQ2 and/or HLA-DQ8 genotypes, Celiac enteropathy found on small bowel biopsy, Response to a GFD(14).