After exclusion of<unk>  disease and wheat allergy, the subsequent step for diagnosis and treatment of NCGS is to start a strict<unk> -free diet (GFD) to assess if symptoms improve or resolve completely. This may occur within days to weeks of starting a GFD, but improvement may also be due to a<unk> -specific, placebo response. The recovery of the nervous system is slow and sometimes incomplete. Recommendations may resemble those for<unk>  disease, for the diet to be strict and maintained, with no transgression. The degree of<unk>  cross contamination tolerated by people with NCGS is not clear but there is some evidence that they can present with symptoms even after consumption of small amounts. Sporadic accidental contaminations with<unk>  can reactivate movement disorders. A part of people with<unk> -related neuropathy or ataxia appears not to be able to tolerate even the traces of<unk>  allowed in most foods labeled as<unk> -free". Whereas<unk>  disease requires adherence to a strict lifelong<unk> -free diet, it is not yet known whether NCGS is a permanent or a transient condition. The results of a 2017 study suggest that NCGS may be a chronic disorder, as is the case with<unk>  disease. A trial of<unk>  reintroduction to observe any reaction after one to two years of strict<unk> -free diet might be performed. A strict<unk> -free diet is effective in most of the neurological disorders associated with NCGS, ameliorating or even resolving the symptoms. It should be started as soon as possible to improve the prognosis. The death of neurons in the cerebellum in ataxia is the result of<unk>  exposure and is irreversible. Early treatment with a strict<unk> -free diet can improve ataxia symptoms and prevent its progression. When dementia has progressed to an advanced degree, the diet has no beneficial effect. Cortical myoclonus appears to be treatment-resistant on both<unk> -free diet and immunosuppression. Persistent symptoms Approximately one third of presumed NCGS patients continue to have symptoms, despite<unk>  withdrawal. Apart from a possible diagnostic error, there are multiple possible explanations. One reason is poor compliance with<unk>  withdrawal, whether voluntary and/or involuntary. There may be ingestion of<unk> , in the form of cross contamination or food containing hidden sources. In some cases, the amelioration of gastrointestinal symptoms with a<unk> -free diet is only partial, and these patients could significantly improve with the addition of a low-FODMAP diet. A subgroup may not improve when eating commercially available<unk> -free products, as these can be rich in preservatives and additives such as sulfites, glutamates, nitrates and benzoates, which can also have a role in triggering functional gastrointestinal symptoms. Furthermore, people with NCGS may often present with IgE-mediated allergies to one or more foods. It has been estimated that around 35% suffer other food intolerances, mainly lactose intolerance.
Non-celiac gluten sensitivity
Hereditary diffuse gastric cancer
Intestinal neuronal dysplasia
Autoimmune gastrointestinal dysmotility
Tropical sprue
Lysinuric protein intolerance
Exocrine pancreatic insufficiency
Foreign body in alimentary tract