Clinical benefit of gluten-free diet in screen-detected older celiac disease patients

Abstract

BackgroundThe utility of serologic screening for celiac disease is still debatable. Evidence suggests that the disorder remains undetected even in the older population. It remains obscure whether screening makes good or harm in subjects with long-standing gluten ingestion. We evaluated whether older subjects benefit from active detection and subsequent gluten free dietary treatment of celiac disease.MethodsThirty-five biopsy-proven patients aged over 50 years had been detected by serologic mass screening. We examined the disease history, dietary compliance, symptoms, quality of life and bone mineral density at baseline and 1-2 years after the commencement of a gluten-free diet. Symptoms were evaluated by gastrointestinal symptom rating scale and quality of life by psychological general well-being questionnaires. Small bowel biopsy, serology, laboratory parameters assessing malabsorption, and bone mineral density were investigated.ResultsDietary compliance was good. The patients had initially low mean serum ferritin values indicating subclinical iron deficiency, which was restored by a gluten-free diet. Vitamin B12, vitamin D and erythrocyte folic acid levels increased significantly on diet. Celiac patients had a history of low-energy fractures more often than the background population, and the diet had a beneficial effect on bone mineral density. Alleviation in gastrointestinal symptoms was observed, even though the patients reported no or only subtle symptoms at diagnosis. Quality of life remained unchanged. Of all the cases, two thirds would have been diagnosed even without screening if the family history, fractures or concomitant autoimmune diseases had been taken carefully into account.ConclusionsScreen-detected patients benefited from a gluten-free diet. We encourage a high index of suspicion and active case-finding in celiac disease as an alternative to mass screening in older patients.

Mujer anciana con diarrea crónica

“…Esta retirada del gluten en los pacientes diagnosticados en la edad adulta provoca una mejoría significativa en síntomas gastrointestinales que podrían incluso haber pasado desapercibidos para el paciente 15 . Así, un estudio publicado recientemente evalúa el efecto beneficioso que la dieta aporta en pacientes mayores de 50 años que habían sido diagnosticados mediante cribado serológico poblacional apreciando una mejoría subjetiva significativa en el GSRS (Gastrointestinal Symptom Rating Scale), y objetiva en los niveles de ferritina, de hemoglobina en mujeres, de vitamina B12, de vitamina D y E 15 .…”

“…Así, un estudio publicado recientemente evalúa el efecto beneficioso que la dieta aporta en pacientes mayores de 50 años que habían sido diagnosticados mediante cribado serológico poblacional apreciando una mejoría subjetiva significativa en el GSRS (Gastrointestinal Symptom Rating Scale), y objetiva en los niveles de ferritina, de hemoglobina en mujeres, de vitamina B12, de vitamina D y E 15 . En esta serie también llama la atención que el 23% de los pacientes tenían una historia de fracturas de baja energía y el 29% estaban diagnosticados de otras enfermedades autoinmunes, por lo que recomiendan realizar cribado en estos subgrupos 15 . En el caso de los pacientes Figura 1.…”

Gluten-free Diet - Tough Alley in Torrid Time

“…Despite the above problematic aspects, it should be noted that CD affected elderlies might benefit and have dramatic improvement on gluten restrictive nutritional therapy [33,34,35]. Recently, it was shown that the compliance to GFD is very good, iron deficient anemia is restored, other nutritional deficiencies and bone mineral density ameliorate, gastrointestinal symptoms, though subtle, were alleviated and histological or serological recovery was virtually complete, in screen-detected older CD patients [34,35]. Older age should not be a barrier to dietary therapy.…”

Coeliac Disease in Later Life: An Interpretive Phenomenological Analysis

“…The GFD omits all products derived from, or containing, gluten, including some medicines [13,14]. Adhering to a GFD facilitates villous regeneration, improved nutrient absorption and amelioration of the physical symptoms [15]. Despite these improvements, initiating a life-long gluten-free diet, for some, is restrictive, difficult to adapt to and challenging to maintain; particularly in older people whose dietary habits are well-established and potentially hard to disrupt [15].…”

“…Adhering to a GFD facilitates villous regeneration, improved nutrient absorption and amelioration of the physical symptoms [15]. Despite these improvements, initiating a life-long gluten-free diet, for some, is restrictive, difficult to adapt to and challenging to maintain; particularly in older people whose dietary habits are well-established and potentially hard to disrupt [15]. Research suggests that working age adults with CD experience various difficulties relating to dietary self-management, including a lack of knowledge, increased cost and difficulties sourcing high quality gluten-free produce [16,17,18].…”