World epidemiology of non-celiac gluten sensitivity.

While the term "gluten" has become commonplace, the disorders associated with gluten still remain poorly understood. Non-celiac gluten sensitivity (NCGS), the most recently recognized of the gluten-related disorders, is arguably the most unknown. While celiac disease and wheat allergy have diagnostic algorithm, NCGS remains a diagnosis of exclusion. With no evidence-based objective diagnostic criteria or serological tests, it is difficult to diagnose and even more difficult to study epidemiologically. Studies often use varied definitions of NCGS and are difficult to compare or validate. Further complicating diagnosis, NCGS has variable and wide-ranging symptoms which overlap with a number of other diseases and changes to diet are inherently difficult to study. In fact, some have argued that NCGS does not exist as a distinct entity or that it may not be caused by the gluten portion of foods. In this review, we outline the current knowledge, hypotheses, and debates surrounding the epidemiology of NCGS in the context of the spectrum of gluten-related disorders.

Sticking to the script: A curious case of confusion in an ESRD patient.

A 60-year-old male Dialysis patient presented with altered mental status and Hypertensive Urgency. He had a significant lesion noted on his glans penis. He was treated for infection and hypertension with expectant management, without significant improvement in his mental acuity. Laboratory and radiologic workup were unrevealing for the etiology. Upon detailed review it was noted he had recently been given Acyclovir for a presumed Herpes Simplex Virus infection. He had been prescribed what is considered correct dosing for an ESRD patient. An Acyclovir level was obtained and urgent Dialysis was undertaken, presuming Acyclovir neurotoxicity may be the culprit. Initially no improvement was noted and a 2nd level and hemodialysis were undertaken. This case and review of the literature will highlight key aspects of acyclovir neurotoxicity in ESRD patients, including how to diagnose and treat, which laboratory tests to obtain and what one can expect from various dialysis modalities. We will also reveal how to dose Acyclovir to avoid toxicity and other key elements of the drug.