The prevalence and causes of chronic diarrhea in patients with celiac sprue treated with a gluten-free diet

Fine, Kenneth D.; Meyer, Richard L.; Lee, Edward L.

doi:10.1053/gast.1997.v112.pm9178673

Cited by 176 publications

(119 citation statements)

References 3 publications

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“…Lack of strict adherence to the GFD is the most common cause of persistent symptoms in CD. 92,93 However, resolution of symptoms may not be accurate in assessing adherence to the GFD as judged by interview and biopsy. 94 Symptoms may also indicate issues other than gluten ingestion; for example, malabsorption of fructose and lactose is common in untreated CD, irritable bowel symptoms may worsen with the GFD because more fruits or 'naturally' gluten-free foods rich in fructose are consumed 95 and occasionally symptoms represent the development of complications such as RCD or lymphoma.…”

Section: Monitoring Adherence To the Gfdmentioning

confidence: 99%

Systematic review: the evidence base for long‐term management of coeliac disease

Haines

Anderson

Gibson

2008

Aliment Pharmacol Ther

182

144

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Section: Monitoring Adherence To the Gfdmentioning

confidence: 99%

Systematic review: the evidence base for long‐term management of coeliac disease

Haines

Anderson

Gibson

2008

Aliment Pharmacol Ther

182

144

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“…Recently, other studies detected that SIBO is a frequent condition in therapy refractory patients with celiac disease [46][47][48] rendering a glucose breath test in celiac patients helpful. Pironti et al 24 concluded in their study that routine duodenal biopsies could be helpful in revealing abnormalities in patients with chronic diarrhea and/or abdominal pain.…”

Section: Discussionmentioning

confidence: 99%

Unclear Abdominal Discomfort: Pivotal Role of Carbohydrate Malabsorption

Goebel-Stengel¹,

Stengel²,

Schmidtmann³

et al. 2014

J Neurogastroenterol Motil

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Background/AimsCarbohydrate malabsorption is frequent in patients with functional gastrointestinal disorders and in healthy volunteers and can cause gastrointestinal symptoms mimicking irritable bowel syndrome (IBS). The aim of this study was to investigate the prevalence of symptomatic lactose and fructose malabsorption in a large population of patients with IBS-like symptoms based on Rome II criteria. MethodsPatients with unclear abdominal discomfort (n = 2,390) underwent lactose (50 g) and fructose (50 g) hydrogen (H 2 ) breath tests and depending on the results further testing with 25 g fructose or 50 g glucose, or upper endoscopy with duodenal biopsies. Additionally, this population was investigated regarding the prevalence of small intestinal bacterial overgrowth (SIBO) based on glucose breath test and celiac disease. ResultsOf the 2,390 patients with IBS-like symptoms, 848 (35%) were symptomatic lactose malabsorbers and 1,531 (64%) symptomatic fructose malabsorbers. A combined symptomatic carbohydrate malabsorption was found in 587 (25%) patients. Severe fructose malabsorbers (pathologic 25 g fructose test) exhaled significantly higher H2 concentrations in the 50 g test than patients with negative 25 g fructose test (P < 0.001). Out of 460/659 patients with early significant H2 increase in the lactose and fructose test who underwent a glucose breath test, 88 patients had positive results indicative of SIBO and they were significantly older than patients with negative test result (P < 0.01). Celiac disease was found in 1/161 patients by upper endoscopy. ConclusionsCarbohydrate malabsorption is a frequent but underestimated condition in patients with IBS-like symptoms although diagnosis can be easily confirmed by H2 breath testing.

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“…NRCD is defined as the persistence of clinical and laboratory abnormalities of CD even after adherence to a GFD for 6-12 months [58,[61][62][63]. It affects 7-30% of patients on a GFD for CD [58,61,62].…”

Section: Non-responsive Celiac Disease (Nrcd)mentioning

confidence: 99%

“…The most common etiology is purposeful or hidden gluten ingestion accounting for 35% to 50% of the cases, hence a dietary referral is warranted in these cases [58,61,62]. The evaluation should also include reconfirmation of the previous diagnosis of CD and ruling out other common causes of similar symptomology including small bowel bacterial overgrowth, food allergies, pancreatic insufficiency, irritable bowel syndrome and refractory celiac disease [58,[61][62][63][64][65]. Since CD and microscopic colitis (MC) overlap [66,67]; MC should be considered in patients with NRCD while CD is considered in patients with unresponsive MC [68].…”

Section: Non-responsive Celiac Disease (Nrcd)mentioning

confidence: 99%

Gluten and the Gut: A Brief Review of Gluten-Related Gastrointestinal Disorders

Shah¹

2017

SOJI

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We conducted online electronic searches (published manuscripts in English) of the Cochrane Library, pub med and manual searches of selected specialty journals to identify any pertinent literature. The search was conducted using the key words 'celiac disease', 'gluten related disorder', 'non celiac gluten sensitivity', 'wheat allergy', 'gluten', , 'gluten free diet'. Studies not published in English or published only in the abstract form were excluded. We also conducted a focused review of available references to identify subsequent pertinent papers. AbstractCeliac disease (CD) was the first gluten-related disorder to be described. Presently the realm of gluten-related disorders also includes non-celiac gluten sensitivity (NCGS) and wheat allergy (WA). CD is a multisystem immune mediated enteropathy observed in genetically susceptible individuals exposed to dietary gluten present in barley, rye and wheat. Although the prevalence of CD is on the rise, it still largely remains under diagnosed given that many cases can be silent, subtle or atypical. The Pathophysiology of CD includes both innate and adaptive immune response to dietary gluten. Patients present with a wide variety of intestinal and extra-intestinal symptoms and are at risk for non-Hodgkin's lymphoma and small intestinal adenocarcinoma. The corner stone for treatment of CD is a gluten-free diet (GFD). NCGS is an emerging condition associated with gluten ingestion and the diagnosis of which is based on exclusion of CD and WA. Further evidence and studies are required to fully appreciate the clinical entity of NCGS and WA to detail its epidemiology and pathogenesis. The symptoms of NCGS and WA may overlap with CD and hence it is imperative to differentiate these clinical entities and select patients for appropriate management.Keywords: Celiac disease, gluten related disorder, non-celiac gluten sensitivity, wheat allergy, gluten, epidemiology, clinical features, Pathophysiology, management, gluten free diet.Core tip: CD is largely under-diagnosed while the incidence and prevalence of gluten-related disorders are on the rise. A clear understanding of the various clinical presentations of gluten-related disorders can help differentiate CD from NCGS and WA. The management for these conditions differs and hence accurate diagnosis leads to improved patient outcomes with avoidance of longterm complications as well as unnecessary testing which can be both invasive and expensive. Celiac DiseaseThe term celiac is derived from the Greek word "koiliaks" meaning "abdominal". It was first described in the second century in modern day Turkey by a Greek physician Aretaeus of Cappadocia [1]. In 1888, Samuel Gee; a pediatrician from the United Kingdom gave the first modern-day description of the condition and associated diet to the treatment of celiac disease EpidemiologyCeliac disease occurs in about 1% of the general population worldwide [7]. Data from the USA suggests CD to be more common in Caucasians as compared to African-Americans and Hispanics [8,9]. The initial ...

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The prevalence and causes of chronic diarrhea in patients with celiac sprue treated with a gluten-free diet

Cited by 176 publications

References 3 publications

Systematic review: the evidence base for long‐term management of coeliac disease

Systematic review: the evidence base for long‐term management of coeliac disease

Unclear Abdominal Discomfort: Pivotal Role of Carbohydrate Malabsorption

Gluten and the Gut: A Brief Review of Gluten-Related Gastrointestinal Disorders

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