Benefiacial Effects Of Gluten Free Diet In Potential Celiac Disease Of The Adult

TY - JOUR

T1 - Benefiacial Effects Of Gluten Free Diet In Potential Celiac Disease Of The Adult

AU - Imperatore, Nicola

AU - Tortora, Raffaella

AU - De Palma, Giovanni Domenico

AU - Capone, Pietro

AU - Gerbino, Nicolò

AU - Donetto, Sara

AU - Testa, Anna

AU - Caporaso, Nicola

AU - Rispo, Antonio

PY - 2017/3/22

Y1 - 2017/3/22

N2 - Background To date, potential coeliac disease (PCD) occurring in adults remains an almost unexplored condition. Aims to explore the prognostic role of Marsh grade in adult PCD patients, and to evaluate the effects of gluten-containing diet (GCD) in asymptomatic PCD patients. Methods We retrospectively evaluated all consecutive adult PCD patients followed-up for at least 6 years. Patients were divided into: Group A (patients with Marsh 0 histology) and Group B (Marsh 1 patients). Symptomatic patients were started gluten-free diet (GFD), while asymptomatic subjects were kept on GCD and were followed-up. Results 56 PCD patients were enrolled (21 in Group A and 35 in Group B). Forty-three patients were symptomatic and started GFD. Of these, none of 15 patients in Group A and 8 of 28 patients in Group B developed immune-mediated disorders (IMD) during follow-up (P = 0.03; OR = 4.2). The 13 asymptomatic PCD patients were kept on GCD. During the follow-up, 9 patients developed CD-related symptoms, 6 villous atrophy and 8 IMD. At the end, patients kept on GCD were at higher risk of developing IMD than those following a GFD (61% vs 18%, P = 0.03, OR = 3.3). Conclusions Although PCD with normal mucosa seems to be a milder disease, the continuation of GCD places patients at a high risk of developing villous atrophy and IMD compared to commencement of GFD. Adult PCD patients should start GFD even if not symptomatic.

AB - Background To date, potential coeliac disease (PCD) occurring in adults remains an almost unexplored condition. Aims to explore the prognostic role of Marsh grade in adult PCD patients, and to evaluate the effects of gluten-containing diet (GCD) in asymptomatic PCD patients. Methods We retrospectively evaluated all consecutive adult PCD patients followed-up for at least 6 years. Patients were divided into: Group A (patients with Marsh 0 histology) and Group B (Marsh 1 patients). Symptomatic patients were started gluten-free diet (GFD), while asymptomatic subjects were kept on GCD and were followed-up. Results 56 PCD patients were enrolled (21 in Group A and 35 in Group B). Forty-three patients were symptomatic and started GFD. Of these, none of 15 patients in Group A and 8 of 28 patients in Group B developed immune-mediated disorders (IMD) during follow-up (P = 0.03; OR = 4.2). The 13 asymptomatic PCD patients were kept on GCD. During the follow-up, 9 patients developed CD-related symptoms, 6 villous atrophy and 8 IMD. At the end, patients kept on GCD were at higher risk of developing IMD than those following a GFD (61% vs 18%, P = 0.03, OR = 3.3). Conclusions Although PCD with normal mucosa seems to be a milder disease, the continuation of GCD places patients at a high risk of developing villous atrophy and IMD compared to commencement of GFD. Adult PCD patients should start GFD even if not symptomatic.

KW - Potential coeliac disease

KW - Marsh

KW - villous atrophy

KW - immuno-mediated disorders

U2 - 10.1016/j.dld.2017.03.009

DO - 10.1016/j.dld.2017.03.009

M3 - Article

SN - 1590-8658

JO - DIGESTIVE AND LIVER DISEASE

JF - DIGESTIVE AND LIVER DISEASE

ER -