Currently, 1% of the United States population holds a diagnosis for celiac disease (CD), however, a more recently recognized and possibly related condition, “non-celiac gluten sensitivity” (NCGS) has been suggested to affect up to 6% of the United States public. While reliable clinical tests for CD exist, diagnosing individuals affected by NCGS is still complicated by the lack of reliable biomarkers and reliance upon a broad set of intestinal and extra intestinal symptoms possibly provoked by gluten. NCGS has been proposed to exhibit an innate immune response activated by gluten and several other wheat proteins. At present, an enormous food industry has developed to supply gluten-free products (GFP) with GFP sales in 2014 approaching $1 billion, with estimations projecting sales to reach $2 billion in the year 2020. The enormous demand for GFP also reflects a popular misconception among consumers that gluten avoidance is part of a healthy lifestyle choice. Features of NCGS and other gluten related disorders (e.g., irritable bowel syndrome) call for a review of current distinctive diagnostic criteria that distinguish each, and identification of biomarkers selective or specific for NCGS. The aim of this paper is to review our current understanding of NCGS, highlighting the remaining challenges and questions which may improve its diagnosis and treatment.

Secukinumab an interleukin-17 (IL-17) monoclonal antibody inhibitor is currently approved for the treatment of rheumatological conditions, such as psoriasis and ankylosing spondylitis. Lymphocytic colitis, a phenotype of microscopic colitis, is a long-term inflammatory condition, is characterized by relapsing diarrhea. The specific entity of drug-induced lymphocytic colitis has been discussed with numerous individual cases being reported from around the world. Secukinumab has been linked with exacerbation of and de novo cases of inflammatory bowel disease. However, lymphocytic colitis in association with this drug has not been documented. The management of drug-induced lymphocytic colitis is complicated, as patients frequently exhibit spontaneous remission of symptoms. Removal of the offending agent has shown some benefit; however, some patients continue to exhibit symptoms months after drug cessation and washout. Although our patient’s lymphocytic colitis was benign and responded to the cessation Secukinumab, it is an important diagnosis to consider in patients with new onset relapsing diarrhea treated with biologics.

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Introduction: Walled Off Pancreatic Necrosis (WOPN) is a result of acute pancreatitis. These cyst cavities have been traditionally drained via an open surgical approaches. More modern approaches with endoscopic drainage and debridment are used effectively for pancreatic pseudocysts and have been used for WOPN. These cases usually require several debridment procedures per patient. Evolution of surgical approaches with less invasive approaches continue to evolve. Case Description/Methods: This video demonstrates a combined endoscopic and laparoscopic approach to debridment of a walled odd pancreatic necrosis through the posterior gastric wall. This approach we have termed "Lap TEC" stands for Laparoscopic Transgastric Endoscopically assisted Cystgastrostomy for a woman several months from an episode of acute pancreatitis resulting in a large symptomatic WOPN. Discussion: Lap TEC is an effective approach for patients with walled off pancreatic necrosis. These patient should be managed by a multidisciplinary team including gastroenterologists and surgeons. Approach chosen for management of WOPN should include patient risk factors, size and location of WOPN, amount of cavitary debris and local expertise. Lap TEC has demonstrated a high degree of safety and efficacy for patient requiring debridment and drainage of WOPN. Watch the video at https://tinyurl.com/ACGAbstractS380

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