Adherence to the gluten‐free diet can achieve the therapeutic goals in almost all patients with coeliac disease: A 5‐year longitudinal study from diagnosis

Newnham, Evan; Shepherd, Susan; Strauss, Boyd Josef Gimnicher; Hosking, Patrick; Gibson, Peter R.

doi:10.1111/jgh.13060

Cited by 65 publications

(57 citation statements)

References 35 publications

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“…In a study of 52 patients who abided by a strict GFD, Newnham et al have reported that it took 5 years for 89% of the subjects to achieve mucosal response [10]. GFD has been shown to result in significant improvement in BMD, although the magnitude of the change shown in studies is far less than was achieved with the combination treatment of GFD and alendronate in our patient.…”

Section: Discussioncontrasting

confidence: 41%

A Remarkable Increase in Bone Mineral Density in Celiac Disease

Szczepanczyk¹,

Saberinia²,

Mirza³

2017

IJCD

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Introduction: Patients with active celiac disease are more likely to have osteoporosis and increased risk of fractures. Studies show that gluten-free diet may help improve bone mass to some extent. Here, we report a premenopausal woman with celiac disease with progressively declining bone mineral density (BMD) into severe osteoporosis range, who demonstrated a remarkable improvement in BMD after one year of gluten-free diet and oral bisphosphonates. Clinical case: A 44-year old premenopausal female had a low screening bone density at the ankle at 39 years of age, and was confirmed to have low BMD by central DXA, with osteoporosis at the spine and osteopenia at the hips. Celiac antibodies were positive and she was recommended gluten free diet (GFD), which she stopped after a year. Her primary care also started her on supplemental calcium and vitamin D with stabilization of BMD over the next three years. Subsequent BMD 2 years later showed 7.6% decrease in bone density at the lumbar spine (T-score -3) and 5.8% decline at the total hip (T-score -2.7) and she was referred for osteoporosis evaluation. Workup revealed high bone turnover with an elevated PTH of 162pg/mL, low normal serum calcium of 8.8mg/dL, normal vitamin D levels and low urine calcium levels, suggestive of secondary hyperparathyroidism. At this time, review of systems revealed a questionable history of gluten sensitivity, but she denied any diarrhea or bloating. A duodenal biopsy revealed villous atrophy and positive antibodies against tissue transglutaminase, compatible with active celiac disease. She was started on a gluten-free diet and alendronate was also added in view of low bone density and high bone resorption. Bone density performed one year later revealed a remarkable 14.1% increase at the level of the lumbar spine and 8.9% increase at the level of total hip compared to prior BMD. Conclusion: This is the first case of such a remarkable increase in BMD on gluten-free diet and concomitant bisphosphonate use, suggesting a cumulative benefit of this strategy that is greater than using either of these interventions alone.

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Section: Discussioncontrasting

confidence: 41%

A Remarkable Increase in Bone Mineral Density in Celiac Disease

Szczepanczyk¹,

Saberinia²,

Mirza³

2017

IJCD

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“…In addition, other causes of villous atrophy should have been excluded and the initial diagnosis of CD should be confirmed. Complete mucosal recovery can take up to 5 years on a GFD (7). RCD is often classified into types 1 and 2 based on immuno-phenotypic aberrancies of intraepithelial lymphocytes (IELs).…”

Section: Defintions Of Refractory Celiac Diseasementioning

confidence: 99%

Current and novel therapeutic strategies in celiac disease

Kurada

Yadav

Leffler

2016

Expert Review of Clinical Pharmacology

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We conducted a search of PubMed and clinicaltrials.gov to extract articles on CD using keywords including 'celiac disease' and 'refractory celiac disease' (RCD) and focused on articles conducting pathophysiologic and therapeutic research in/ex-vivo models and human trials. We highlight novel therapeutics that manipulate these mechanisms including tight junction regulators, glutenases, gluten sequestrants and immunotherapy using vaccines, nanoparticles that may serve as adjuncts to a GFD or more ambitiously to allow for gluten consumption. We also highlight the role of anti-inflammatories, immunosuppressants and monoclonal antibodies in RCD. Expert commentary: Therapeutics including tight junction regulators, glutenases have the potential to be approved for non-responsive CD or as gluten adjuncts. We expect results of various phase 1/2 trials using AMG 714, BL 7010, IgY antibodies to be published. In the interim, off-label use of 5 amino-salicylates, budesonide, nucleoside analogues and newer biologics developed for other inflammatory diseases will be used in RCD.

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“…Es interesante que un 24,1% de los pacientes (7 niños), a pesar de pensar que están haciendo mal el régimen, ya sea porque comen gluten en forma evidente o porque no tienen clara las indicaciones de alimentación, mantienen ambas serologías negativas. Esto apoya la idea que la serología no es un buen indicador para hacer el seguimiento (11,(27)(28)(29) ; abre también la posibilidad que algunos pacientes tengan cierta tolerancia a cantidades pequeñas de gluten sin que se despierte en ellos la respuesta autoinmune detectable (30) . Otra posibilidad es que el tiempo transcurrido entre la trasgresión de la dieta y la medición de marcadores haya sido insuficiente para producir el cambio detectable.…”

Section: Discussionunclassified

Percepción de estar haciendo bien la dieta sin gluten y adherencia al tratamiento en pacientes pediátricos con enfermedad celíaca

Schilling

Yohannessen

Araya

2018

Rev. chil. pediatr.

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Percepción de estar haciendo bien la dieta sin gluten y adherencia al tratamiento en pacientes pediátricos con enfermedad celíaca ResumenIntroducción: La enfermedad celíaca (EC) es una enteropatía crónica mediada inmunológicamente que afecta ~1% de la población. La dieta libre de gluten (DLG) es su único tratamiento y la principal limitante de su eficacia es la falta de adherencia. Objetivos: Evaluar factores que influyen en la adherencia a la DLG de pacientes celiacos pediátricos. Medir la concordancia entre la serología y un cuestionario nutricional de adherencia. Pacientes y Método: Estudio transversal en celiacos menores de 18 años, en DLG por más de 6 meses. Se aplicó un cuestionario con 5 grupos de factores (OMS). Se registraron características clínicas, dieta de los últimos 3 meses, percepción (de padres/cuidadores, y del paciente adolescente) de la DLG; el conocimiento de los alimentos permitidos y disponibles en el país de la simbología "libre de gluten", y si lee/no lee ingredientes de un alimento antes de comprarlo. Se aplicó un score dando un punto a cada respuesta correcta (0-4). A un subgrupo se le aplicó el cuestionario de adherencia a la DLG de Biagi. Se midió EMA y TTG dentro de las 2 semanas posteriores a la entrevista. Se usó índice Kappa para evaluar la concordancia entre TTG y encuesta nutricional de adherencia; Chi cuadrado para la asociación entre los factores evaluados y los resultados de EMA y TTG, y Odds ratio como medida de asociación. Se aplicó un modelo de regresión logística a los factores asociados a los resultados de los exámenes de anticuerpos EMA y TTG (positivo-negativo). Se definió "buena adherencia a la DLG" cuando EMA y TTG fueron negativos. Resultados: De 65 pacientes; 44% y 30,1% adherían correctamente a la DLG según medición de anticuerpos (TTG y EMA) y el cuestionario, respectivamente. La "edad de inicio de la enfermedad" (p = 0,049), "percepción de estar realizando bien la DLG" (p = 0,002) y la "conducta del paciente frente a alimentos en reuniones sociales" (p = 0,005), se asociaron significativamente con adherencia a DLG. Hubo concordancia entre los exámenes serológicos y el cuestionario de adherencia (p = 0,0001). Discusión: La adherencia fue menor que la reportada en la literatura. La intervención de variables asociadas a adherencia identificadas, podría ayudar al mejor seguimiento de los pacientes, especialmente en aquellos quienes por diversos motivos no puedan realizarse exámenes serológicos con la frecuencia adecuada. 217ARTÍCULO ORIGINAL AbstractIntroduction: Celiac disease (CD) is a chronic immune-mediated enteropathy present in ~1% of population. Gluten-free diet (GFD) is the only treatment for this condition and the main limitation of its efficacy is the lack of adherence. Objective: To assess factors influencing adherence to GFD in pediatric patients and measure the concordance between serological results and a nutritional adherence questionnaire. Patients and Methods: celiac patients younger than 18 years of age, diagnosed CD following ESPGHAN criteria, ...

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Adherence to the gluten‐free diet can achieve the therapeutic goals in almost all patients with coeliac disease: A 5‐year longitudinal study from diagnosis

Cited by 65 publications

References 35 publications

A Remarkable Increase in Bone Mineral Density in Celiac Disease

A Remarkable Increase in Bone Mineral Density in Celiac Disease

Current and novel therapeutic strategies in celiac disease

Percepción de estar haciendo bien la dieta sin gluten y adherencia al tratamiento en pacientes pediátricos con enfermedad celíaca

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