PTU-156 Dietary response in coeliac disease should be assessed by repeat duodenal biopsy

Abstract

million (ppm) using a QuinTron BreathTracker DP at baseline, thendafter 75 g oral glucosedat 20 min time points up to 3 h or until positive. Positive test: fasting H 2 $20 or CH 4 $10 ppm or a rise in H 2 $12 or CH 4 $6 ppm. Some patients also had duodenal aspirates collected endoscopically. Positive result: >10 4 colony forming units/ml. Patients with positive tests were treated with antibiotics. Results were assessed retrospectively. Results 126 patients, 66 males and 60 females, median group age 61 years (range 35e86), treated for gynaecological (30%), upper GI (25%), lower GI (9%), urological (28%), other cancers (10%d myeloma, ependymoma, bronchial, breast and lymphoma) were referred. Daily troublesome GI symptoms included flatulence (85%), borborygmi (63%), belching (54%), bloating (52%), abdominal pain (50%), steatorrhoea (38%), nausea/vomiting (23%) and diarrhoea (19%). 60 (48%) had a positive breath testd5% H2, 10% CH4 and 33% both gases. 21 (17%) of 86 patients with D2 aspirates tested positive for Streptococcus (n¼6), E. Coli (3), Candida (3), Klebsiella (2), Enterococcus (2), Pseudomonas (2), Neisseria (1), Aeromonas (1) and Stenotrophomonas (1). 17 (33%) had negative breath tests. Six of these had positive D2 aspirates with 3 (50%) responsive to antibiotics, 11 had negative aspirates but a 73% antibiotic response rate. 24 (46%) tested positive for both gases. 33% of these had a positive D2 aspirate with a 75% response rate to antibiotics and 67% negative aspirates but 81% response. Six patients (12%) were positive only for H2 (all had negative aspirates), 1 responded to antibiotics. 5 (10%) tested positive for CH4 only, of which 1 had a positive D2 aspirate with a response to antibiotics and 4 (80%) had negative aspirate but 2 responded. Conclusion Methane breath testing identifies 10% more patients with SIBO compared to the glucose hydrogen breath test alone. D2 aspirate increases the detection rate by 12%. A trial of antibiotics, with other tests negative, benefits 15% of patients. All current diagnostic methods are flawed. Better diagnostic tests for SIBO are required.

The management of refractory coeliac disease

“…Clearly the length of time for mucosal recovery to occur depends on the patient's learning curve for dietary gluten exclusion. In a study performed in Cambridge, approximately 25% of patients reverted to normal intestinal mucosa within a year, with a further 30% showing minor inflammation without villous atrophy [Corbett et al 2012]. In those with ongoing villous atrophy, similar proportions respond to more stringent dietary gluten exclusion with mucosal recovery [Sharkey et al 2012].…”