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Celiac Symptoms Common Despite Dietary Adherence

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A retrospective follow-up study in Italy found that nearly half of patients with celiac disease experienced clinically relevant events despite being highly adherent to a gluten-free diet (GFD).

These events are rarely caused by poor dietary adherence (4%) or complications (2%), reported Annalisa Schiepatti, MD, of the University of Pavia, Italy, and colleagues.

The main causes of these clinical events during follow-up of the 189 patients studied were functional gastrointestinal (GI) disorders (30%), gastroesophageal reflux disease (18%), and micronutrient deficiencies. (10%), the authors write. Gastrointestinal disease and science.

“Based on our results, the high prevalence of functional gastrointestinal disorders, gastroesophageal reflux disease, and micronutrient deficiencies during GFD is important in addition to strict lifelong adherence to GFD. As an intervention, we suggest a possible role for rebalancing dietary quality,” they said. OK.

No significant relationship was found between GFD adherence and event occurrence on follow-up biopsy.

Eamonn Quigley, M.D., Ph.D., Houston Methodist Hospital, Texas, said, “The 30% number of functional gastrointestinal disorders may sound high, but it is also likely to occur in the general population, depending on which criteria are used. I see it at about the same rate,” he said. Today’s Medpage. “One of the questions we see in all such articles is how confident are our patients that they are strictly adhering to a gluten-free diet and are in complete remission of their celiac disease? is.”

“Our own research suggests that low-grade inflammation may explain some of these symptoms in both inflammatory bowel disease and celiac disease,” said a member of the study. Not so, Quigley said.

Despite using GFD, as many as 30% of celiac patients may not achieve complete resolution of symptoms and histologic lesions.

For this study, Schiepatti and colleagues used medical record data from Italian referral centers in 189 celiac patients who followed long-term GFD after undergoing duodenal biopsy from 2000 to 2021. I checked. Dietary adherence was assessed until his 2008.

In contrast to previous reports, most patients in this study had good adherence to the GFD after excluding 13 patients with missing data (90.9%). Overall, 50.3% had ongoing symptoms at follow-up, 37% had persistent symptoms at diagnosis despite her GFD, and 24.6% developed new symptoms.

Of the patients, 88 had a clinical event, with an overall incidence of 83.5 per 1,000 person-years (95% CI 70.9-97.6). A clinically relevant event was defined as any sign or symptom that occurred during follow-up and required diagnostic testing, treatment, emergency room access, or even hospitalization.

The mean age at diagnosis was 36 years, and 70% of patients were female. The average follow-up he had was 112 months. He, who had at least one clinical event, had the classic pattern of celiac disease at diagnosis and was more than twice as likely as her to have persistent villous atrophy at follow-up duodenal biopsy.

Even after an average of 16 months from diagnosis, 15.4% had ‘some degree’ of villous atrophy on duodenal biopsy. Among them, most showed early but incomplete histological improvement despite good adherence to GFD (18 of 29). Less common were poor adherence to GFD (n = 9) or complicated celiac disease (n = 2).

Eleven patients with villous atrophy had persistent symptoms on follow-up biopsy.

Predictors of clinically relevant events included age ≥45 years at diagnosis (HR 1.68, 95% CI 1.05-2.69) and presenting with the classic pattern of celiac disease (HR 1.63, 95% CI 1.04-2.54) were included.

The disease-free rate was 65% at 5 years and 51% at 10 years. Of the 157 events, 92 required outpatient treatment, 63 required diagnostic testing, and 13 required emergency room treatment or hospitalization. Common symptoms leading to clinical events included gastroesophageal reflux in 19%, diarrhea in 15% and dyspepsia in 13%. In particular, 63 diagnostic tests were performed, including upper gastrointestinal endoscopic biopsy (44%), colonoscopy (21%), or abdominal ultrasonography (11%).

Among patients aged 45 years or older at diagnosis, 46% with classic celiac disease and 62% with non-classic or asymptomatic celiac disease remained event-free at 5 years and 25% and 47% at 10 years, respectively. Event-free rates were higher in those under 45 years of age, with 60% of patients with classic celiac disease and 80% of patients with non-classic or silent celiac disease remaining event-free at 5 years and 10 years of age. 51% and 60%, respectively, remained event-free years.

Five patients died after a mean follow-up of 146 months after diagnosis. All of whom had at least one clinical event during follow-up.

The authors acknowledged the limitations of this study, including the single-center design and limited sample size. No standardized method of classifying heterogeneous symptoms was used.

  • Zaina Hamza Staff writer for MedPage Today, covering gastroenterology and infectious diseases. She is based in Chicago.


This research was supported by open access funding from the Università degli Studi di Pavia under the CRUI-CARE agreement.

Schiepatti and co-authors do not disclose any competing interests.

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