Management of celiac disease in daily clinical practice

Elli, Luca; Ferretti, Francesca; Orlando, Stefania; Vecchi, Maurizio; Monguzzi, Erika; Roncoroni, Leda; Schuppan, Detlef

doi:10.1016/j.ejim.2018.11.012

Cited by 60 publications

(57 citation statements)

References 140 publications

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“…CD is the most common autoimmune enteropathy in the Western countries, and strict lifelong GFD is considered the only available treatment, usually inducing symptomatic remission, mucosal healing, and normalization of the serological alterations [3]. However, looking at GFD without a "dogmatic" point of view, a number of ambiguities and/or questions arise [15]: what is the prognosis of patients occasionally assuming gluten?…”

Section: Discussionmentioning

confidence: 99%

“…CD is characterized by an impaired immune response in genetically susceptible individuals (carrying the HLA DQ2 and/or DQ8 haplotypes) and leads to the inflammation and atrophy of the small bowel (SB) mucosa [2]. As a consequence, the classical clinical picture of CD is characterized by nutrient malabsorption with several signs of malnutrition, but extra-intestinal symptoms and association with other autoimmune disorders are frequently present as signs of systemic disease [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…Nowadays, CD is considered a permanent condition of immunological intolerance to gluten, which requires strict lifelong gluten-free diet (GFD) [3]. The withdrawal of gluten from a patient's diet usually results in the recovery of his/her intestinal mucosa with an improvement of symptoms, SB absorption, and normalization of the circulating autoantibody (anti-type 2 transglutaminase IgA, TG2) [5].…”

Section: Introductionmentioning

confidence: 99%

“…Although safe and efficient, GFD is very restrictive, resulting as a burden on social life and quality of life (for both patients and caregivers) [7][8][9][10] and frequently with poor compliance [11][12][13]. Moreover, the clinical response to inadvertent or voluntary gluten ingestion by treated CD patients can be very heterogeneous, ranging from gastroenteritislike pictures to no symptoms [3,14]. Consequently, patients' motivation or understanding in the following strict GFD is often poor.…”

Section: Introductionmentioning

confidence: 99%

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Safety of occasional ingestion of gluten in patients with celiac disease: a real-life study

Elli

Bascuñán

Lernia

et al. 2020

BMC Med

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Background: Gluten-free diet (GFD) decreases the quality of life of celiac disease (CD) patients, who frequently ask to occasionally ingest gluten-containing food. We evaluated CD patients reporting voluntary and occasional transgressions to their GFD. Methods: From October 2017 to September 2018, the patients reporting occasional and voluntary gluten ingestion (GFD-noncompliant) were prospectively enrolled. These patients underwent clinical examination, blood tests, duodenal biopsy, capsule enteroscopy (CE), and a validated food-frequency questionnaire (FFQ) assessing the frequency and quantity of gluten intake. Mortality was calculated and compared to the general population. A group of patients on strict GFD (GFD-adherent) acted as controls. Results: One thousand three hundred seventy-eight CD patients were evaluated during the study period. One hundred nine (8%) reported occasional (weekly or monthly) voluntary ingestion of gluten. The mean gluten intake was 185.2 ± 336.9 g/year, and the duration of their incorrect GFD was 8.6 ± 6.9 years. Among the noncompliant patients, 57% did not present any histological alteration; furthermore, the Marsh score profile was not different between compliant and noncompliant patients. Seventy percent did not present any alteration at CE. Seventy-five percent of patients reported no gastrointestinal symptoms after gluten ingestion. Twenty-three percent of patients in the GFD-noncompliant group presented positive tTG-IgA. No association was found between gluten intake, clinical symptoms, and biomarkers. Mortality was not different between the groups and the general population. Conclusions: Our results are that in a real-life scenario, a group of CD patients on long-term gluten intake showed no significant clinical symptoms or small bowel damage, thus suggesting that a degree of tolerance towards gluten consumption can be reached.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Safety of occasional ingestion of gluten in patients with celiac disease: a real-life study

Elli

Bascuñán

Lernia

et al. 2020

BMC Med

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“…Its prevalence is about 1%, and since the small intestine is its main target organ, CD can have gluten-related gastrointestinal manifestations, such as bloating, abdominal pain, diarrhea, and constipation [1][2][3]. What is more, CD is a multisystem disorder, and patients can also complain of extraintestinal signs and symptoms [4,5]. CD diagnosis in adults is usually based on positive results of specific serological tests for anti-endomysial antibodies (EMA) and anti-tissue transglutaminase (tTG) antibodies performed during a free diet and then confirmed by the finding of intestinal villous atrophy on histological examination of duodenal biopsies.…”

Section: Introductionmentioning

confidence: 99%

Beneficial Effects of a Low-Nickel Diet on Relapsing IBS-Like and Extraintestinal Symptoms of Celiac Patients during a Proper Gluten-Free Diet: Nickel Allergic Contact Mucositis in Suspected Non-Responsive Celiac Disease

et al. 2020

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Background and Aim: Nickel (Ni)-rich foods can induce allergic contact mucositis (ACM) with irritable bowel syndrome (IBS)-like symptoms in predisposed subjects. Ni ACM has a high prevalence (>30%) in the general population and can be diagnosed by a Ni oral mucosa patch test (omPT). Many celiac disease (CD) patients on a gluten-free diet (GFD) often show a recrudescence of gastrointestinal and extraintestinal symptoms, although serological and histological remission has been achieved. Since a GFD often results in higher loads of ingested alimentary Ni (e.g., corn), we hypothesized that it would lead to a consequent intestinal sensitization to Ni in predisposed subjects. We wanted to (1) study Ni ACM prevalence in still symptomatic CD patients on a GFD and (2) study the effects of a low-Ni diet (LNiD) on their recurrent symptoms. Material and Methods: We recruited 102 consecutive CD patients (74 female, 28 male; age range 18–65 years, mean age 42.3 ± 7.4) on a GFD since at least 12 months, in current serological and histological remission (Marsh–Oberhuber type 0–I) who complained of relapsing gastrointestinal and/or extraintestinal symptoms. Inclusion criteria: presence of at least three gastrointestinal symptoms with a score ≥5 on the modified Gastrointestinal Symptom Rating Scale (GSRS) questionnaire. Exclusion criteria: IgE-mediated food allergy; history of past or current cancer; inflammatory bowel diseases; infectious diseases including Helicobacter pylori; lactose intolerance. All patients enrolled underwent Ni omPT and followed a LNiD for 3 months. A 24 symptoms questionnaire (GSRS modified according to the Salerno Experts’ Criteria, with 15 gastrointestinal and 9 extraintestinal symptoms) was administered at T0 (free diet), T1 (GFD, CD remission), T2 (recurrence of symptoms despite GFD), and T3 (GFD + LNiD) for comparisons. Comparisons were performed using Wilcoxon signed-rank test. RESULTS: Twenty patients (all female, age range 23–65 years, mean age 39.1 ± 2.9) out of 102 (19.6%) were finally included. All 20 patients enrolled (100%) showed positive Ni omPT, confirming an Ni ACM diagnosis. A correct GFD (T0 vs. T1) induced the improvement of 19 out of the total 24 (79.2%) symptoms, and 14 out of 24 (58.3%) were statistically significant (p-value < 0.0083 according to Bonferroni correction). Prolonged GFD (T1 vs. T2) revealed the worsening of 20 out of the total 24 (83.3%) symptoms, and 10 out of 24 (41.7%) were statistically significant. LNiD (T2 vs. T3) determined an improvement of 20 out of the total 24 (83.4%) symptoms, and in 10 out of 24 (41.7%) symptoms the improvement was statistically significant. Conclusions: Our data suggest that the recrudescence of gastrointestinal and extraintestinal symptoms observed in CD subjects during GFD may be due to the increase in alimentary Ni intake, once gluten contamination and persisting villous atrophy are excluded. Ni overload can induce Ni ACM, which can be diagnosed by a specific Ni omPT. Improvement of symptoms occurs after a proper LNiD. These encouraging data should be confirmed with larger studies.

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Application of Soy, Corn, and Bean By-products in the Gluten-free Baking Process: A Review

Egea

Sousa

Santos

et al. 2023

Food Bioprocess Technol

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Management of celiac disease in daily clinical practice

Cited by 60 publications

References 140 publications

Safety of occasional ingestion of gluten in patients with celiac disease: a real-life study

Safety of occasional ingestion of gluten in patients with celiac disease: a real-life study

Beneficial Effects of a Low-Nickel Diet on Relapsing IBS-Like and Extraintestinal Symptoms of Celiac Patients during a Proper Gluten-Free Diet: Nickel Allergic Contact Mucositis in Suspected Non-Responsive Celiac Disease

Application of Soy, Corn, and Bean By-products in the Gluten-free Baking Process: A Review

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