Currently, gluten challenge is no longer required to confirm the diagnosis in patients with intestinal lesions compatible with coeliac disease and a positive response to a gluten-free diet. Nevertheless, in some cases, a gluten challenge with a subsequent biopsy may be useful to support the diagnosis, for example in people with a high suspicion for coeliac disease, without a biopsy confirmation, who have negative blood antibodies and are already on a gluten-free diet. Gluten challenge is discouraged before the age of 5 years and during pubertal growth. The alternative diagnosis of non-coeliac gluten sensitivity may be made where there is only symptomatic evidence of gluten sensitivity. Gastrointestinal and extraintestinal symptoms of people with non-coeliac gluten sensitivity can be similar to those of coeliac disease, and improve when gluten is removed from the diet, after coeliac disease and wheat allergy are reasonably excluded.Up to 30% of people often continue having or redeveloping symptoms after starting a gluten-free diet. A careful interpretation of the symptomatic response is needed, as a lack of response in a person with coeliac disease may be due to continued ingestion of small amounts of gluten, either voluntary or inadvertent, or be due to other commonly associated conditions such as small intestinal bacterial overgrowth (SIBO), lactose intolerance, fructose, sucrose, and sorbitol malabsorption, exocrine pancreatic insufficiency, and microscopic colitis, among others. In untreated coeliac disease, these are often transient conditions derived from the intestinal damage.
At the time of the purchase, a proposal for a merger under Swiss merger law was given to the Alcon board of directors. The merger was agreed upon on December 15, 2010, making Alcon "the second largest division within Novartis." The merger was completed on April 8, 2011.Ilevro was launched by Alcon on January 21, 2013. In 2014 and 2015, net sales by Alcon grew, contributed to in part by the increased volume in sales of Ilevro. That financial year, Novartis reported $18 billion in total financial debt. That figure has grown steadily since. In 2016, Novartis reported a total debt of $23.8 billion, up from the $21.9 billion reported in 2015  and the $20.4 billion reported in 2014. As of May 2017, Novartis is estimated to be worth $193.2 billion.On January 27, 2016, Alcon was moved to become a branch of the Innovative Medicines Division at Novartis. Early in 2016, Alcon formed agreements with both TrueVision and PowerVision, and acquired Transcend Medical. As of January 2017, Novartis is weighing options for Alcon in the business structure. Commercial risks
Alcon faced declining growth in 2016, having faced challenges in development and marketing of new products. Marketing
Novartis maintains a detailing unit geared toward health professionals consisting of over 3,000 employees within the United States and an additional 21,000 worldwide. Novartis is also seeking to expand direct-to-consumer advertising and entrance into specialty product markets.