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Related Concept Videos

Sensitivity, Specificity, and Predicted Value01:13

Sensitivity, Specificity, and Predicted Value

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In healthcare diagnostics, laboratory tests play a crucial role in identifying and diagnosing a wide range of medical conditions. However, interpreting test results is not always straightforward. An abnormal test result does not always confirm the presence of a disease, just as a normal result does not guarantee its absence. To assess the reliability of these diagnostic tools, healthcare practitioners rely on two key statistical indicators: sensitivity and specificity.
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Film Extrusion of Crambe abyssinica/Wheat Gluten Blends
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Nonceliac Gluten and Wheat Sensitivity.

Anam Khan1, Milena Gould Suarez1, Joseph A Murray2

  • 1Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas.

Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
|April 13, 2019
PubMed
Summary

Non-celiac gluten and/or wheat sensitivity (NCGS) is an immune-mediated condition causing various symptoms. Diagnosis remains challenging due to a lack of strict criteria and potential nocebo effects, necessitating a multidisciplinary approach.

Keywords:
Glutendietgluten-related disordersnon-celiac gluten sensitivitynutrition

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Area of Science:

  • Gastroenterology
  • Immunology
  • Nutrition Science

Background:

  • Non-celiac gluten and/or wheat sensitivity (NCGS) presents with intestinal and extraintestinal symptoms, improving upon dietary elimination of wheat or gluten.
  • Skepticism exists regarding NCGS as a distinct disorder due to a lack of standardized diagnostic criteria and limited prevalence studies.
  • The pathogenesis of NCGS is not well understood, with no established biomarkers or diagnostic histological findings.

Purpose of the Study:

  • To review the diagnostic challenges and management strategies for non-celiac gluten and/or wheat sensitivity (NCGS).
  • To highlight the importance of placebo-controlled rechallenge trials in diagnosing NCGS.
  • To emphasize the need for a multidisciplinary approach in managing suspected NCGS.

Main Methods:

  • Review of existing literature on non-celiac gluten and/or wheat sensitivity (NCGS) diagnosis and management.
  • Discussion of diagnostic criteria, including placebo-controlled rechallenge trials (double-blind in research, single-blind in clinical practice).
  • Exploration of potential triggers beyond gluten, such as fructans and amylase trypsin inhibitors.

Main Results:

  • Diagnostic criteria for NCGS are not uniform, leading to variable study results and reliance on patient-reported symptoms.
  • The nocebo effect significantly impacts existing studies on NCGS prevalence and diagnosis.
  • A multidisciplinary team approach involving various medical specialists and nutritionists is crucial for accurate diagnosis and treatment.

Conclusions:

  • Accurate diagnosis of NCGS is hindered by the absence of strict criteria and the influence of the nocebo effect.
  • Placebo-controlled rechallenge trials are recommended for diagnosis, though their implementation varies between research and clinical settings.
  • Management should involve dietary adjustments, potentially targeting both gluten and fructans, alongside patient education on long-term dietary implications.