Trace gluten contamination may play a role in mucosal and clinical recovery in a subgroup of diet-adherent non-responsive celiac disease patients

BMC Gastroenterology

Research Article

Alessio Fasano¹  Justin R Hollon²  Elaine L Leonard Puppa³  Margaret L Martin³  Pamela A Cureton⁴ 

[1] Center for Celiac Research, Massachusetts General Hospital and Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital for Children, Boston, MA, USA;Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Brady 320, Baltimore, MD, USA;University of Maryland School of Medicine, Baltimore, MD, USA;University of Maryland School of Medicine, Baltimore, MD, USA;Center for Celiac Research, Massachusetts General Hospital and Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital for Children, Boston, MA, USA;

关键词: Celiac disease;    Refractory celiac disease;    Refractory sprue;    Non-responsive celiac disease;    Gluten-free diet;   

DOI  :  10.1186/1471-230X-13-40

 received in 2012-10-26, accepted in 2013-02-25,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundPatients with persistent symptoms and/or villous atrophy despite strict adherence to a gluten-free diet (GFD) have non-responsive celiac disease (NRCD). A subset of these patients has refractory celiac disease (RCD), yet some NRCD patients may simply be reacting to gluten cross-contamination. Here we describe the effects of a 3-6 month diet of whole, unprocessed foods, termed the Gluten Contamination Elimination Diet (GCED), on NRCD. We aim to demonstrate that this diet reclassifies the majority of patients thought to have RCD type 1 (RCD1).MethodsWe reviewed the records of all GFD-adherent NRCD patients cared for in our celiac center from 2005-2011 who were documented to have started the GCED. Response to the GCED was defined as being asymptomatic after the diet, with normal villous architecture on repeat biopsy, if performed.ResultsPrior to the GCED, all patients were interviewed by an experienced dietitian and no sources of hidden gluten ingestion were identified. 17 patients completed the GCED; 15 were female (88%). Median age at start of the GCED was 42 years (range 6-73). Fourteen patients (82%) responded to the GCED. Six patients met criteria for RCD prior to the GCED; 5 (83%) were asymptomatic after the GCED and no longer meet RCD criteria. Of the 14 patients who responded to the GCED, 11 (79%) successfully returned to a traditional GFD without resurgence of symptoms.ConclusionsThe GCED may be an effective therapeutic option for GFD-adherent NRCD patients. Response to this diet identifies a subgroup of patients, previously classified as RCD1, that is not truly refractory to dietary treatment. Preventing an inaccurate diagnosis of RCD1 avoids immunotherapy. Most patients are able to return to a traditional GFD without return of symptoms.

【 授权许可】

CC BY   
© Hollon et al.; licensee BioMed Central Ltd. 2013