Relevance. Although monotherapy with a gluten-free diet (BGD) for celiac disease is highly effective, it does not in all cases achieve complete remission of the disease. Therefore, an additional comprehensive examination of patients for the purpose of prescribing reasonable therapy is relevant.
Objective: to study the causes of the persistence of clinical symptoms in patients with celiac disease who are on a gluten-free diet for 6 months.
Materials and methods. Patients with celiac disease (n = 41) who were on a gluten-free diet (GFD) for 6 months were studied. The average age is 35.42 ± 0.45 years. Group 1 (n = 17) – patients who subjectively noted a positive dynamics of treatment and with a significant improvement in general condition, but without complete clinical remission. Group 2 (n = 24) – patients with unsatisfactory treatment results, no clinical effect from treatment, or weak positive dynamics on the background of GFD. The study included two stages: 1) assessment of patients' compliance and their diet (through the analysis of food diaries) in order to identify disorders of a gluten-free diet as the main cause of the persistence of clinical symptoms; 2) identification of other causes of the persistence of symptoms: exocrine pancreas insufficiency (EPI), lactase deficiency (LD) and the syndrome of increase bacterial growth (SIBR). A C13 triglyceride breath test (IRIS analyzer) was performed to diagnose EPI. To diagnose LD and SIBR in the small intestine, hydrogen breath tests (Micro H2-meter analyzer) were used – a test with lactose and D-xylose, respectively. Also, the titer of antibodies to tissue transglutaminase (TTG) to deaminated gliadin peptides (DPG) was determined in all patients, and their DPG/TTG ratio was calculated.
Results. The main reason for the ineffectiveness of treatment is a violation of a gluten-free diet, found in 63.4% of subjects (incompletely formed mushy stool, polyfaeces, steatorrhea; recurrent abdominal pain, bloating, flatulence). Revision of food intake and elimination of sources of latent gluten from the diet of patients with celiac disease allowed to achieve complete serological remission (normalization of titers specific for celiac disease antibodies) in all patients, but complete clinical remission was achieved in only 34.6%. Therefore, it is concluded that there are other causes of incomplete remission of celiac disease associated with concomitant diseases of the digestive tract. Using carbon and hydrogen breath tests, it was found that, in addition to diet, the reasons for the lack of complete remission in patients with celiac disease are EPI (19%), SIBR in the small intestine (16%), LD (47%) and a combination of EPI with SIBR.
Conclusion. The inclusion of respiratory tests (C13-triglyceride, hydrogen with lactose, and D-xylose) in a comprehensive examination of patients with celiac disease can significantly improve treatment outcomes and reduce the duration of clinical remission.
Challenges of Monitoring the Gluten-Free Diet Adherence in the Management and Follow-Up of Patients with Celiac Disease
