So how do we test those patients? Do we ask them to challenge themselves with gluten and do the simple TTG antibody test, whether that's serum IgA, or do we do genetic testing or endoscopy? What do you think is the best approach?

Sure.

It depends a little bit on the details of the clinical case.

For example, if someone's only been off wheat or gluten for about a week, that's okay.

You can test right now today in the clinic with a ttgiga because it's pretty unlikely that that would normalize so quickly in someone with celiac disease but after a few weeks or a month then i get nervous that this is a patient that might have celiac disease but they're not keeping enough gluten in their diet for it to be detected and so when that's the case there are a couple things we do One is we offer genetic testing for DQ2 and DQ8.

These are components of our HLA immune system, and these are very common haplotypes.

40% of us are positive for DQ2 or DQ8, and the great majority of people with that result, it doesn't really have any significance.

Can you help our listeners with the distinction between celiac disease and non-gluten wheat sensitivity? You know, really, what does that term mean? And is that still the best term, non-celiac wheat sensitivity for patients who don't have celiac disease but have symptoms while ingesting wheat?