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

Abstract

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.

Relationship between Persistent Gastrointestinal Symptoms and Duodenal Histological Findings after Adequate Gluten-Free Diet: A Gray Area of Celiac Disease Management in Adult Patients

“…In our study, we tried to improve the reliability of the GFD adherence assessment by a careful interview performed by two dedicated physicians. It is also important to highlight that occasional GFD transgressions did not always influence the development of villous atrophy independently of symptoms, as shown by a recent study [ 30 ]. In addition, considering data that could indirectly provide us with information on possible gluten ingestion, such as persistent CD-specific antibody positivity and duodenal histological damage [ 31 ], at the time of histological re-evaluation, no significant differences were found between the two groups.…”

What is the Optimal Method Assessing for Persistent Villous Atrophy in Adult Coeliac Disease?

“…Owing to the difficulty of GFD adherence, the learning process involved in achieving adequate adherence is a proposed reason [20]. Another explanation could be gradual development of gluten tolerance [44,45]. A recent large prospective study reported that among non-adherent patients, 57% achieved Marsh 0 histology and 66% had only non-atrophic lesions [44].…”

“…Another explanation could be gradual development of gluten tolerance [44,45]. A recent large prospective study reported that among non-adherent patients, 57% achieved Marsh 0 histology and 66% had only non-atrophic lesions [44]. Thus, among CD patients sporadically ingesting gluten-containing foods, a degree of tolerance towards gluten can be achieved [44].…”

Nutritional and Gastroenterological Monitoring of Patients With Celiac Disease During COVID-19 Pandemic: The Emerging Role of Telemedicine and Point-of-Care Gluten Detection Tests

“…Furthermore, in selected cases, the use of point-of-care and self-administered tests to monitor GFD (such as urinary GIP) could give an important support. A proportional fraction of GIP absorbed reaches the circulation and is excreted in the urine, allowing for a better evaluation of patients' adherence to GFD compared to serology (which has low specificity and sensitivity in determining both adherence to the gluten-free diet and healing of the intestinal mucosa) and to frequent repetition of biopsies ( 19 ). It has been demonstrated that they are a valuable aid for celiac patients to monitor their GFD, improving adherence and checking for accidental gluten ingestion ( 9 , 12 ).…”