Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology

Ludvigsson, Jonas F.; Bai, Julio C.; Biagi, Federico; Card, Timothy R.; Ciacci, Carolina; Ciclitira, Paul J.; Green, Peter H. R.; Hadjivassiliou, Marios; Holdoway, Anne; Heel, David A. van; Kaukinen, Katri; Leffler, Daniel A.; Leonard, J.N.; Lundin, Knut E.A.; McGough, Norma; Davidson, Mike; Murray, Joseph A.; Swift, G. L.; Walker, Marjorie M.; Zingone, Fabiana; Sanders, David S.

doi:10.1136/gutjnl-2013-306578

Cited by 946 publications

(1,142 citation statements)

References 301 publications

Supporting

Mentioning

1,063

Contrasting

Unclassified

Order By: Relevance

“…From a clinical point of view, regardless of the additional factors that may be implicated in the relationship and its direction, identification of, and support to improve, poor adherence and depression/depressive symptoms in CD should be considered to reduce the burden of illness associated with deficiencies in both physical and mental health. Based on these tentative findings, there may be a role for psychological services in addition to dietetic input in the ongoing management and follow-up of GFD adherence for affected CD patients (Ludvigsson et al, 2014;NICE, 2015), even in cases of low-level, subclinical depressive symptoms (NICE, 2009). Online and face-to-face interventions using both individual and group-based formats have shown promise in improving GFD adherence and psychological wellbeing in CD (Addolorato et al, 2004;Ring Jacobsson, Friedrichsen, Goransson, & Hallert, 2012;Sainsbury, Mullan, & Sharpe, 2013c), and could help to achieve needed improvements in both directions.…”

Section: Resultsmentioning

confidence: 99%

“…Debate exists on the optimal way to measure GFD adherence (Leffler et al, 2007;Ludvigsson et al, 2014;Vahedi et al, 2003), resulting in large variation in definitions and measurement across studies (Hall, Rubin, & Charnock, 2009). Intentional gluten consumption in patients with CD appears rare, with unintentional non-adherence (e.g., due to cross contamination or errors in label reading) representing the most common reason for lapsing from the GFD (Hall, Rubin, & Charnock, 2013;Sainsbury et al, 2013a).…”

Section: Introductionmentioning

confidence: 99%

“…with Likert or visual analogue response scales from 'not at all' to 'very strictly') and serological analyses, are unreliable at detecting incomplete adherence, particularly with increased time on a GFD (Leffler et al, 2007). These methods also do not correlate well with dietitian-rated assessments (Fera, Cascio, Angelini, Martini, & Guidetti, 2003;Leffler et al, 2007;Vahedi et al, 2003), the method currently deemed the 'gold standard' (Leffler et al, 2007;Ludvigsson et al, 2014). The dietitian assessment involves completion of a 3-day food record (prior to the session), a food ingredient quiz, and a dynamic clinical interview in which an experienced dietitian evaluates the food record with the patient to identify any gluten consumption or sources of cross-contamination that may compromise adherence.…”

Section: Introductionmentioning

confidence: 99%

“…Current guidelines on the management of CD (Ludvigsson et al, 2014;NICE, 2015) and other chronic physical health problems (NICE, 2009) specify that mild-to-severe depression and subclinical depressive symptoms should be recognised and treated. A potential association between depression and GFD adherence in CD would therefore have important implications for the assessment and treatment of patients, including the goals of optimising adherence and both physical and psychological wellbeing.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The relationship between gluten free diet adherence and depressive symptoms in adults with coeliac disease: A systematic review with meta-analysis

Sainsbury

Marques

2018

Appetite

View full text Add to dashboard Cite

Conflicts of interest: none Funding: none 2The relationship between gluten free diet adherence and depressive symptoms in adults with coeliac disease: A systematic review with meta-analysis ABSTRACT Purpose: Depressive symptoms are common in patients with coeliac disease (CD) and may represent a barrier to gluten free diet (GFD) adherence. The aims of this meta-analysis were: (1) to synthesise the evidence on the relationship between depression or depressive symptoms and degree of adherence to a GFD in patients with CD who are already attempting a GFD (i.e., post-diagnosis and onset of GFD), and (2) to summarise the direction of causation of any observed relationship. Methods:A random effects meta-analysis of 8 cross-sectional studies (N=1644) was conducted.Included studies measured self-reported depressive symptoms and GFD adherence using either a dietitian interview or validated self-report questionnaire that considered unintentional gluten consumption.Results: There was a moderate association between poorer GFD adherence and greater depressive symptoms (r=0.398, 95% CI=0.321-0.469), with marked heterogeneity in the effects (I 2 =66.8%). A sensitivity analysis excluding studies with a moderate/high (k=1) or unclear risk of bias (k=1) did not change the results. Conclusion:The low number of studies meeting inclusion criteria limits the strength of the conclusions. Available evidence suggests there is an association between poorer GFD adherence and self-reported depressive symptoms; however, studies using longitudinal and prospective designs, and reliable measures, particularly for adherence, are needed to confirm this association. The direction of causation between depression and adherence remains unclear.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The relationship between gluten free diet adherence and depressive symptoms in adults with coeliac disease: A systematic review with meta-analysis

Sainsbury

Marques

2018

Appetite

View full text Add to dashboard Cite

show abstract

“…increased risk of malignancies, bone fractures or infertility. 2 However, in some cases, laboratory and histological findings are inconsistent with symptoms presented by patients and are insufficient for straightforward diagnosis. Different factors can influence serology or histopathological results reducing their sensitivity and specificity.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic challenges in celiac disease

et al. 2017

View full text Add to dashboard Cite

Diagnosis of celiac disease in adults is currently based on serologic tests in combination with histopathological assessment of small intestinal biopsy specimens. High titers of celiac-specific antibodies in immunocompetent patients with villous atrophy in a good quality biopsy sample allow us to state a confident diagnosis. The relief of symptoms and histological improvement after embarking on a gluten free diet further support the initial diagnosis. However, in some cases, these conditions are not fulfilled, which requires a critical evaluation of laboratory and histopathology results and a consideration of other potential causes for the observed pathologies. To avoid diagnostic uncertainty, both biopsy and laboratory testing should be performed on a diet containing gluten. Immune deficiency, cross reaction of antibodies and possibilities of seronegative or latent celiac disease should be considered while evaluating serology results. Uneven distribution and variable intensity of histopathological changes in the small intestine along with multiple disorders presenting a similar specimen image may lead to invalid biopsy results. Additional laboratory testing and careful examination of a patient's history may deliver important data for a differential diagnosis and a more specific biopsy evaluation. Persistence or recurrence of symptoms, despite the ongoing treatment, requires a revision of the initial diagnosis, an evaluation of the gluten free diet and a search for concurrent disorders or complications.

show abstract

Association Between Celiac Disease and Mortality Risk in a Swedish Population

Lebwohl

Green

Söderling

et al. 2020

JAMA

119

113

View full text Add to dashboard Cite

IMPORTANCE Celiac disease may be associated with a modest but persistent increased long-term mortality risk. It is uncertain whether this risk has changed in the era of wider diagnosis rates, less severe clinical disease, and more widespread availability of gluten-free food. OBJECTIVE To evaluate the association between celiac disease and mortality risk in a population-based cohort in Sweden. DESIGN, SETTING, AND PARTICIPANTS All individuals in Sweden with celiac disease diagnosed between 1969 and 2017 were identified through the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) cohort. Participants (n = 49 829) were observed starting on the day of the biopsy. The final date of follow-up was December 31, 2017. EXPOSURES Celiac disease was defined by the presence of small intestinal villus atrophy on histopathology specimens during the years 1969-2017 from Sweden's 28 pathology departments. Each individual was matched with as many as 5 control participants in the general population by age, sex, county, and calendar period. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality, and the secondary outcome was cause-specific mortality. Patients with celiac disease were compared with controls using stratified Cox proportional modeling, stratifying by year of diagnosis. RESULTS There were 49 829 patients with celiac disease, including 24% who were diagnosed between the years 2010 and 2017. The mean (SD) age at diagnosis was 32.2 (25.2) years and 62.4% were women. During a median follow-up time of 12.5 years, 13.2% (n = 6596) died. Compared with controls (n = 246 426), overall mortality was increased in those with celiac disease (9.7 vs 8.6 deaths per 1000 person-years; absolute difference, 1.2 per 1000 person-years; hazard ratio [HR], 1.21 [95% CI, 1.17-1.25]). The relative increase in mortality risk was present in all age groups and was greatest in those diagnosed in the age range of 18 to 39 years (1.9 vs 1.1 per 1000 person-years; HR, 1.69 [95% CI, 1.47-1.94]; P values for heterogeneity comparing 18-39 years with 40-59 years and with Ն60 years were both <.001). Individuals with celiac disease were at increased risk of death from cardiovascular disease (3.5 vs 3.4 per 1000 person-years; HR, 1.08 [95% CI, 1.02-1.13]), cancer (2.7 vs 2.2 per 1000 person-years; HR, 1.29 [95% CI, 1.22-1.36]), and respiratory disease (0.6 vs 0.5 per 1000 person-years; HR, 1.21 [95% CI, 1.08-1.37]). When compared with controls, the overall mortality risk was greatest in the first year after diagnosis (15.3 vs 6.5 per 1000 person-years; HR, 2.34 [95% CI, 2.14-2.55]) but persisted beyond 10 years after diagnosis (10.5 vs 10.1 per 1000 person-years; HR, 1.15 [95% CI, 1.10-1.20]). The mortality risk was likewise present for patients diagnosed during the years 2010-2017 (7.5 vs 5.5 per 1000 person-years; HR, 1.35 [95% CI, 1.21-1.51]). CONCLUSIONS AND RELEVANCE In a Swedish population studied between 1969 and 2017, a diagnosis of celiac disease compared with the general population was associated with a smal...

show abstract

Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology

Cited by 946 publications

References 301 publications

The relationship between gluten free diet adherence and depressive symptoms in adults with coeliac disease: A systematic review with meta-analysis

The relationship between gluten free diet adherence and depressive symptoms in adults with coeliac disease: A systematic review with meta-analysis

Diagnostic challenges in celiac disease

Association Between Celiac Disease and Mortality Risk in a Swedish Population

Contact Info

Product

Resources

About