scholarly journals A score that verifies adherence to a gluten-free diet: a cross-sectional, multicentre validation in real clinical life

2012 ◽  
Vol 108 (10) ◽  
pp. 1884-1888 ◽  
Author(s):  
Federico Biagi ◽  
Paola Ilaria Bianchi ◽  
Alessandra Marchese ◽  
Lucia Trotta ◽  
Claudia Vattiato ◽  
...  
Keyword(s):  
Coeliac Disease ◽  
Villous Atrophy ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Cross Sectional ◽  
Simple Method ◽  
Endomysial Antibodies ◽  
Dietary Interview

A dietary interview performed by expert personnel is the best method to check whether patients with coeliac disease follow a strict gluten-free diet (GFD). We previously developed a score based on four fast and simple questions that can be administered even by non-expert personnel. The aim of the present study is to verify the reliability of our questionnaire in a new cohort of patients. The questionnaire has a five-level score. From March 2008 to January 2011, the questionnaire was administered to 141 coeliac patients on a GFD, who were undergoing re-evaluation. The score obtained was compared with persistence of both villous atrophy and endomysial antibodies (EMA). The rate of lower scores was higher among the patients with persistence of either villous atrophy (Fisher's exact, P < 0·001; test for trend, P < 0·001) or positive EMA (Fisher's exact, P = 0·001; test for trend, P = 0·018). Given that the coeliac patients have been well instructed on what a GFD means and on how to follow it, our questionnaire is a reliable and simple method to verify compliance to a GFD.

scholarly journals A gluten-free diet score to evaluate dietary compliance in patients with coeliac disease

2009 ◽  
Vol 102 (6) ◽  
pp. 882-887 ◽  
Author(s):  
Federico Biagi ◽  
Alida Andrealli ◽  
Paola Ilaria Bianchi ◽  
Alessandra Marchese ◽  
Catherine Klersy ◽  
...  
Keyword(s):  
Coeliac Disease ◽  
Villous Atrophy ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Efficient Tool ◽  
Simple Method ◽  
Dietary Compliance ◽  
Endomysial Antibodies ◽  
Diet Score ◽  
Dietary Interview

A dietary interview performed by expert personnel is considered to be the most appropriate tool to check whether patients with coeliac disease follow a strict gluten-free diet. However, we currently have no straightforward and non-subjective method for performing such a dietary interview. We therefore developed a fast questionnaire based on four simple questions with a five-level score (0–IV). To verify whether our questionnaire is an efficient tool, we applied it to 168 coeliac patients (126 females and 42 males; mean age 42·4 (sd 12·9) years) on a gluten-free diet (median 82, 25th–75th percentile 50–108, range 15–389 months). The score we obtained was compared with the persistence of both villous atrophy and endomysial antibodies while on a gluten-free diet. A comparison with survival of the patients was also performed. Patients were interviewed over the phone by non-expert personnel. The questionnaire was completed in less than 1 min. The lowest results were significantly more frequent among the patients with a persistence of both villous atrophy and positive endomysial antibodies. Death risk was also significantly correlated with the lowest score results. We conclude that our questionnaire is a reliable and simple method of verifying compliance with a gluten-free diet.

scholarly journals Determinants of adherence to gluten-free diet in Greek children with coeliac disease: a cross-sectional study

2013 ◽  
Vol 67 (6) ◽  
pp. 615-619 ◽  
Author(s):  
D Charalampopoulos ◽  
J Panayiotou ◽  
G Chouliaras ◽  
A Zellos ◽  
E Kyritsi ◽  
...  
Keyword(s):  
Coeliac Disease ◽  
Cross Sectional Study ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Sectional Study ◽  
Cross Sectional

scholarly journals Symposium 1: Joint BAPEN and British Society of Gastroenterology Symposium on ‘Coeliac disease: basics and controversies’ Coeliac disease: optimising the management of patients with persisting symptoms?

2009 ◽  
Vol 68 (3) ◽  
pp. 242-248 ◽  
Author(s):  
Kate E. Evans ◽  
David S. Sanders
Keyword(s):  
Coeliac Disease ◽  
Management Strategy ◽  
Villous Atrophy ◽  
Management Plan ◽  
Gluten Free Diet ◽  
British Society ◽  
Gluten Free ◽  
Review Of The Literature ◽  
Refractory Coeliac Disease ◽  
Investigation Strategy

The vast majority of patients with coeliac disease will derive benefit from a gluten-free diet. However, some patients will not improve on the gluten-free diet or they will have a relapse of their symptoms. The present review will focus on this group of patients. Definitions for non-responsive coeliac disease and refractory coeliac disease will be provided. The most common reason for recurrent symptoms is continued gluten exposure. Other causes of persisting symptoms are discussed, including alternative causes of villous atrophy or co-existent pathology. Current literature is reviewed, including an initial investigation strategy for patients with persisting symptoms. A pragmatic management plan is described that can be initiated by any clinician. Finally, the current optimal investigational pathway for patients with refractory (or suspected refractory) coeliac disease is discussed and the reported effects of a number of therapeutic options are summarised. The aim of the present article is to provide clinicians with an up-to-date review of the literature in this clinical field and allow them to determine the most appropriate management strategy.

scholarly journals The relationship between gluten free diet adherence and depressive symptoms in adults with coeliac disease: A systematic review with meta-analysis

2017 ◽  
Author(s):  
Kirby Sainsbury ◽  
Marta M Marques
Keyword(s):  
Depressive Symptoms ◽  
Coeliac Disease ◽  
Meta Analysis ◽  
Gluten Free Diet ◽  
Self Report ◽  
Gluten Free ◽  
Cross Sectional ◽  
High K ◽  
Direction Of Causation ◽  
The Relationship

Purpose: Depressive symptoms are common in patients with coeliac disease (CD) and may represent a barrier to gluten free diet (GFD) adherence. The aims of this meta-analysis were: (1) to synthesise the evidence on the relationship between depression or depressive symptoms and degree of adherence to a GFD in patients with CD who are already attempting a GFD (i.e., post-diagnosis and onset of GFD), and (2) to summarise the direction of causation of any observed relationship. Methods: A random effects meta-analysis of 8 cross-sectional studies (N=1644) was conducted. Included studies measured self-reported depressive symptoms and GFD adherence using either a dietitian interview or validated self-report questionnaire that considered unintentional gluten consumption.Results: There was a moderate association between poorer GFD adherence and greater depressive symptoms (r=0.398, 95% CI=0.321-0.469), with marked heterogeneity in the effects (I2=66.8%). A sensitivity analysis excluding studies with a moderate/high (k=1) or unclear risk of bias (k=1) did not change the results. Conclusion: The low number of studies meeting inclusion criteria limits the strength of the conclusions. Available evidence suggests there is an association between poorer GFD adherence and self-reported depressive symptoms; however, studies using longitudinal and prospective designs, and reliable measures, particularly for adherence, are needed to confirm this association. The direction of causation between depression and adherence remains unclear.

scholarly journals The Role of the Gluten-Free Diet in the Management of Seronegative Enteropathy

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 4027
Author(s):  
Anna Szaflarska-Popławska
Keyword(s):  
Differential Diagnosis ◽  
Coeliac Disease ◽  
Immunosuppressive Therapy ◽  
Villous Atrophy ◽  
Gluten Free Diet ◽  
Evidence Based ◽  
Gluten Free ◽  
Clinical Challenge ◽  
Immune Mediated

The differential diagnosis and treatment of seronegative enteropathy, also termed seronegative villous atrophy (SNVA), is a clinical challenge. Although seronegative coeliac disease (CD) is a frequent cause of SNVA, the aetiology can include immune-mediated, inflammatory, infectious, and drug-related forms. As a misdiagnosis of SNVA can result in patients being unnecessarily placed on a lifelong strict gluten-free diet or even given incorrect immunosuppressive therapy, the aim of this paper is to provide an evidence-based and practical approach for the workup and management of SNVA.

scholarly journals Differential IL-13 Production by Small Intestinal Leukocytes in Active Coeliac Disease versus Refractory Coeliac Disease

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Sascha Gross ◽  
Roy L. van Wanrooij ◽  
Petula Nijeboer ◽  
Kyra A. Gelderman ◽  
Saskia A. G. M. Cillessen ◽  
...  
Keyword(s):  
Coeliac Disease ◽  
Potential Role ◽  
Cytokine Production ◽  
Villous Atrophy ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Strict Adherence ◽  
Aberrant Phenotype ◽  
Small Intestinal ◽  
Production Pattern

A small fraction of coeliac disease (CD) patients have persistent villous atrophy despite strict adherence to a gluten-free diet. Some of these refractory CD (RCD) patients develop a clonal expansion of lymphocytes with an aberrant phenotype, referred to as RCD type II (RCDII). Pathogenesis of active CD (ACD) has been shown to be related to gluten-specific immunity whereas the disease is no longer gluten driven in RCD. We therefore hypothesized that the immune response is differentially regulated by cytokines in ACD versus RCDII and investigated mucosal cytokine release after polyclonal stimulation of isolated mucosal lymphocytes. Secretion of theTH2cytokine IL-13 was significantly higher in lamina propria leukocytes (LPLs) isolated from RCDII patients as compared to LPL from ACD patients(P=0.05). In patients successfully treated with a gluten-free diet LPL-derived IL-13 production was also higher as compared to ACD patients(P=0.02). IL-13 secretion correlated with otherTH2as well asTH1cytokines but not with IL-10 secretion. Overall, the cytokine production pattern of LPL in RCDII showed more similarities with LPL isolated from GFD patients than from ACD patients. Our data suggest that different immunological processes are involved in RCDII and ACD with a potential role for IL-13.

scholarly journals Comparative Study of Salivary, Duodenal, and Fecal Microbiota Composition Across Adult Celiac Disease

2020 ◽  
Vol 9 (4) ◽  
pp. 1109 ◽  
Author(s):  
Simona Panelli ◽  
Enrica Capelli ◽  
Giuseppe Francesco Damiano Lupo ◽  
Annalisa Schiepatti ◽  
Elena Betti ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Villous Atrophy ◽  
Duodenal Mucosa ◽  
Fecal Microbiota ◽  
Gluten Free Diet ◽  
Microbiota Composition ◽  
Gluten Free ◽  
Cross Sectional ◽  
Adult Celiac Disease ◽  
Tertiary Center

Background: Growing evidence suggests that an altered microbiota composition contributes to the pathogenesis and clinical features in celiac disease (CD). We performed a comparative analysis of the gut microbiota in adulthood CD to evaluate whether: (i) dysbiosis anticipates mucosal lesions, (ii) gluten-free diet restores eubiosis, (iii) refractory CD has a peculiar microbial signature, and (iv) salivary and fecal communities overlap the mucosal one. Methods: This is a cross-sectional study where a total of 52 CD patients, including 13 active CD, 29 treated CD, 4 refractory CD, and 6 potential CD, were enrolled in a tertiary center together with 31 controls. A 16S rRNA-based amplicon metagenomics approach was applied to determine the microbiota structure and composition of salivary, duodenal mucosa, and stool samples, followed by appropriate bioinformatic analyses. Results: A reduction of both α- and β-diversity in CD, already evident in the potential form and achieving nadir in refractory CD, was evident. Taxonomically, mucosa displayed a significant abundance of Proteobacteria and an expansion of Neisseria, especially in active patients, while treated celiacs showed an intermediate profile between active disease and controls. The saliva community mirrored the mucosal one better than stool. Conclusion: Expansion of pathobiontic species anticipates villous atrophy and achieves the maximal divergence from controls in refractory CD. Gluten-free diet results in incomplete recovery. The overlapping results between mucosal and salivary samples indicate the use of saliva as a diagnostic fluid.

Micronutrient deficiencies in children with coeliac disease; a double-edged sword of both untreated disease and treatment with gluten-free diet

2021 ◽  
Author(s):  
Lorcan McGrogan ◽  
Mary Mackinder ◽  
Fiona Stefanowicz ◽  
Maria Aroutiounova ◽  
Anthony Catchpole ◽  
...  
Keyword(s):  
Coeliac Disease ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Micronutrient Deficiencies

scholarly journals Wait-and-See Approach or Gluten-Free Diet Administration—The Rational Management of Potential Coeliac Disease

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 947
Author(s):  
Anna Szaflarska-Popławska
Keyword(s):  
Small Intestine ◽  
Celiac Disease ◽  
Prognostic Factors ◽  
Coeliac Disease ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Individual Basis ◽  
Therapeutic Decisions ◽  
Rational Management ◽  
Wait And See

Potential celiac disease (PCD) is a heterogeneous disease; only some patients develop full celiac disease (CD), characterised by advanced atrophic changes in the small intestine. Few accurate prognostic factors exist for the progression of PCD; therefore, therapeutic decisions should be made on an individual basis in each case. Patients with clinical gastroenterological or parenteral symptoms often benefit from a gluten-free diet, and those left on a diet containing gluten should receive clinical, serological and histopathological supervision.

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