Descriptive Study of the Different Tools Used to Evaluate the Adherence to a Gluten-Free Diet in Celiac Disease Patients

Celiac disease (CD) is a genetically conditioned autoimmune process that appears in susceptible people. It can affect people of any age, and slightly predominates in females. It has a fairly homogenous global distribution, with an average prevalence of 1–2%, the frequency having increased in recent decades. The only effective treatment is a strict and permanent gluten-free diet (GFD), although the level of compliance is poor, at about 50% of cases. To monitor the effectiveness of the GFD, several procedures involving various approaches are employed: (a) Periodic visits by expert Nutritionists; (b) Clinical follow-up; (c) Serological time controls of specific antibodies; (d) Serial endoscopies with collection of duodenal biopsies; (e) Use of structured questionnaires; and (f) Determination of gluten peptides derived from gluten in faeces and/or urine. All of these procedures are useful when applied, alone or in combination, depending on the cases. Some patients will only need to consult to their doctors, while others will require a multidisciplinary approach to assess their compliance with the GFD. In children, normalization of duodenal mucosa was achieved in 95% of cases within two years, while it is more delayed in adults, whose mucosa take longer time (3–5 years) to heal completely.

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Evaluation of Efficacy and Adherence to Gluten-Free Diet in Patients with Celiac Disease

10.20944/preprints201810.0324.v1 ◽

2018 ◽

Author(s):

Luis Rodrigo ◽

Isabel Perez-Martinez ◽

Eugenia Lauret-Braña ◽

Adolfo Suarez-Gonzalez

Keyword(s):

Celiac Disease ◽

Multidisciplinary Approach ◽

Duodenal Mucosa ◽

Gluten Free Diet ◽

Gluten Free ◽

Autoimmune Process ◽

Specific Antibodies ◽

Duodenal Biopsies

Celiac disease (CD) is a genetically conditioned autoimmune process that appears in susceptible people. It can affect people of any age, and slightly predominates in females. It has a fairly homogenous global distribution, with an average prevalence of 1-2%, the frequency having increased in recent decades. The only effective treatment is a strict and permanent gluten-free diet (GFD), although the level of compliance with it is poor, at about 50% of cases. To monitor the effectiveness of the GFD, several procedures involving various approaches are employed: a) periodic interviews by nutritionists; b) clinical follow-up; c) serological controls of specific antibodies; d) endoscopies with collection of duodenal biopsies; e) structured questionnaires; f) determination of gluten peptides derived from gluten in feces and/or urine. All of these procedures are useful when applied, alone or in combination, depending on the cases. Some patients will only need to consult to their doctors, while others will require a multidisciplinary approach to assess their compliance with the GFD. In children, normalization of duodenal mucosa was achieved in 95% of cases within 2 years, while it is more delayed in adults, whose mucosa take longer to heal completely.

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Rationale for Timing of Follow-Up Visits to Assess Gluten-Free Diet in Celiac Disease Patients Based on Data Mining

Nutrients ◽

10.3390/nu13020357 ◽

2021 ◽

Vol 13 (2) ◽

pp. 357

Author(s):

Alfonso Rodríguez-Herrera ◽

Joaquín Reyes-Andrade ◽

Cristina Rubio-Escudero

Keyword(s):

Data Mining ◽

Celiac Disease ◽

Cultural Context ◽

Gluten Free Diet ◽

Gluten Free ◽

Adherence To Diet ◽

And Gender ◽

Few Data

The assessment of compliance of gluten-free diet (GFD) is a keystone in the supervision of celiac disease (CD) patients. Few data are available documenting evidence-based follow-up frequency for CD patients. In this work we aim at creating a criterion for timing of clinical follow-up for CD patients using data mining. We have applied data mining to a dataset with 188 CD patients on GFD (75% of them are children below 14 years old), evaluating the presence of gluten immunogenic peptides (GIP) in stools as an adherence to diet marker. The variables considered are gender, age, years following GFD and adherence to the GFD by fecal GIP. The results identify patients on GFD for more than two years (41.5% of the patients) as more prone to poor compliance and so needing more frequent follow-up than patients with less than 2 years on GFD. This is against the usual clinical practice of following less patients on long term GFD, as they are supposed to perform better. Our results support different timing follow-up frequency taking into consideration the number of years on GFD, age and gender. Patients on long term GFD should have a more frequent monitoring as they show a higher level of gluten exposure. A gender perspective should also be considered as non-compliance is partially linked to gender in our results: Males tend to get more gluten exposure, at least in the cultural context where our study was carried out. Children tend to perform better than teenagers or adults.

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Are Complicated Forms of Celiac Disease Cryptic T-Cell Lymphomas?

Blood ◽

10.1182/blood.v92.10.3879 ◽

1998 ◽

Vol 92 (10) ◽

pp. 3879-3886 ◽

Cited By ~ 94

Author(s):

Franck Carbonnel ◽

Laurence Grollet-Bioul ◽

Jean Claude Brouet ◽

Marie Françoise Teilhac ◽

Jacques Cosnes ◽

...

Keyword(s):

Bone Marrow ◽

Celiac Disease ◽

T Cell ◽

Cell Lymphoma ◽

Large Cell ◽

Cell Receptor ◽

T Cell Lymphoma ◽

Gluten Free Diet ◽

Gluten Free ◽

Duodenal Biopsies

Abstract We assessed the clonality of duodenal mucosal T cells in patients with celiac disease and controls. Fifteen adult patients were studied. Four patients had a complicated celiac disease, 3 did not respond to a gluten-free diet, and 2 had an ulcerative jejunitis (including 1 patient with nonresponsive celiac disease). Seven patients had an untreated celiac disease responsive to a gluten-free diet. Histological examination of duodenal biopsies of these 11 patients showed benign-appearing celiac disease without evidence of lymphoma. Four patients with nonulcer dyspepsia and normal duodenal biopsies served as controls. TCRγ gene rearrangements were analyzed by multiplex polymerase chain reaction on DNA extracted from duodenal biopsies. Major clonal rearrangements of the T-cell receptor were found in 4 cases, all with complicated celiac disease. Monoclonality was confirmed by DNA sequencing of the junctional region in 3 cases and by hybridization with clone-specific oligoprobes. Patients with celiac disease responsive to gluten-free diet had mainly a polyclonal pattern, with 1 of them having an oligoclonal rearrangement. An oligoclonal pattern was also observed in 2 control patients. Three patients with complicated celiac disease evolved to T-cell lymphoma with liver (n = 2) or bone marrow (n = 1) invasion. Identical clones were found in the enteropathic duodenojejunum and peripheral blood in the patient with large-cell lymphoma with bone marrow invasion. This study suggests that complicated celiac disease is a cryptic T-cell lymphoma.

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Compliance with gluten-free diet in adolescents with screening-detected celiac disease: A 5-year follow-up study

The Journal of Pediatrics ◽

10.1067/mpd.2000.105351 ◽

2000 ◽

Vol 136 (6) ◽

pp. 0841-0843 ◽

Cited By ~ 32

Author(s):

Elisabetta Fabiani ◽

Luciana Maria Taccari ◽

Ilse-Maria R[auml ]tsch ◽

Silvia Di Giuseppe ◽

Giovanni Valentino Coppa ◽

...

Keyword(s):

Celiac Disease ◽

Gluten Free Diet ◽

Gluten Free ◽

Follow Up Study

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Are Complicated Forms of Celiac Disease Cryptic T-Cell Lymphomas?

Blood ◽

10.1182/blood.v92.10.3879.422k34_3879_3886 ◽

1998 ◽

Vol 92 (10) ◽

pp. 3879-3886

Author(s):

Franck Carbonnel ◽

Laurence Grollet-Bioul ◽

Jean Claude Brouet ◽

Marie Françoise Teilhac ◽

Jacques Cosnes ◽

...

Keyword(s):

Bone Marrow ◽

Celiac Disease ◽

T Cell ◽

Cell Lymphoma ◽

Large Cell ◽

Cell Receptor ◽

T Cell Lymphoma ◽

Gluten Free Diet ◽

Gluten Free ◽

Duodenal Biopsies

We assessed the clonality of duodenal mucosal T cells in patients with celiac disease and controls. Fifteen adult patients were studied. Four patients had a complicated celiac disease, 3 did not respond to a gluten-free diet, and 2 had an ulcerative jejunitis (including 1 patient with nonresponsive celiac disease). Seven patients had an untreated celiac disease responsive to a gluten-free diet. Histological examination of duodenal biopsies of these 11 patients showed benign-appearing celiac disease without evidence of lymphoma. Four patients with nonulcer dyspepsia and normal duodenal biopsies served as controls. TCRγ gene rearrangements were analyzed by multiplex polymerase chain reaction on DNA extracted from duodenal biopsies. Major clonal rearrangements of the T-cell receptor were found in 4 cases, all with complicated celiac disease. Monoclonality was confirmed by DNA sequencing of the junctional region in 3 cases and by hybridization with clone-specific oligoprobes. Patients with celiac disease responsive to gluten-free diet had mainly a polyclonal pattern, with 1 of them having an oligoclonal rearrangement. An oligoclonal pattern was also observed in 2 control patients. Three patients with complicated celiac disease evolved to T-cell lymphoma with liver (n = 2) or bone marrow (n = 1) invasion. Identical clones were found in the enteropathic duodenojejunum and peripheral blood in the patient with large-cell lymphoma with bone marrow invasion. This study suggests that complicated celiac disease is a cryptic T-cell lymphoma.

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Mo1043 - Determination of Gluten Consumption by Celiac Disease Patients on a Gluten-Free Diet

Gastroenterology ◽

10.1016/s0016-5085(18)32404-1 ◽

2018 ◽

Vol 154 (6) ◽

pp. S-681-S-682

Author(s):

Jennifer A. Sealey Voyksner ◽

Jack A. Syage ◽

Matthew A. Dickason ◽

Ciaran P. Kelly ◽

Francisco Leon ◽

...

Keyword(s):

Celiac Disease ◽

Gluten Free Diet ◽

Gluten Free

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Celiac Disease and the Gluten-Free Diet: Consequences and Recommendations for Improvement

Digestive Diseases ◽

10.1159/000369504 ◽

2015 ◽

Vol 33 (2) ◽

pp. 175-182 ◽

Cited By ~ 52

Author(s):

Thimmaiah G. Theethira ◽

Melinda Dennis

Keyword(s):

Celiac Disease ◽

Critical Role ◽

Nutrition Therapy ◽

Gluten Free Diet ◽

Nutritional Deficiencies ◽

Gluten Free ◽

Immune Mediated ◽

Macro And Micronutrients ◽

Medical Nutrition

Background: Celiac disease (CD) is a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically susceptible individuals. CD-related enteropathy leads to multiple nutritional deficiencies involving macro- and micronutrients. Currently, medical nutrition therapy consisting of the gluten-free diet (GFD) is the only accepted treatment for CD. Key Messages: The GFD is the cornerstone of treatment for CD. Prior published studies have concluded that maintenance of the GFD results in improvement of the majority of nutritional deficiencies. In the past, counseling for CD focused mainly on the elimination of gluten in the diet. However, the GFD is not without its inadequacies; compliance to the GFD may result in certain deficiencies such as fiber, B vitamins, iron, and trace minerals. Paucity of fortified gluten-free foods may be responsible for certain deficiencies which develop on the GFD. Weight gain and obesity have been added to the list of nutritional consequences while on the GFD and have been partially attributed to hypercaloric content of commercially available gluten-free foods. Follow-up of patients diagnosed with CD after starting the GFD has been reported to be irregular and, hence, less than ideal. Conclusions: Monitoring of the nutritional status using blood tests and use of appropriate gluten-free supplementation are integral components in the management of CD. The ideal GFD should be nutrient-dense with naturally gluten-free foods, balanced with macro- and micronutrients, reasonably priced, and easily accessible. Rotation of the pseudo-cereals provides a good source of complex carbohydrates, protein, fiber, fatty acids, vitamins and minerals. Fortification/enrichment of commonly consumed gluten-free commercial grain products should be encouraged. Dietitians specializing in CD play a critical role in the education and maintenance of the GFD for patients with CD.

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