Clinical benefit of gluten-free diet in screen-detected older celiac disease patients

BMC Gastroenterology

Research Article

Heikki Patrikainen¹  Ilkka Krekelä¹  Pekka Collin²  Katri Kaukinen²  Liisa Luostarinen³  Anitta Vilppula³  Markku Luostarinen⁴  Kaija Laurila⁵  Markku Mäki⁶  Raisa Valve⁷ 

[1] Department Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland;Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland;School of Medicine, University of Tampere, Finland;Department of Neurology, Päijät-Häme Central Hospital, Lahti, Finland;Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland;Paediatric Research Centre, University of Tampere and Tampere University Hospital, Tampere, Finland;School of Medicine, University of Tampere, Finland;Paediatric Research Centre, University of Tampere and Tampere University Hospital, Tampere, Finland;University of Helsinki, Department of Education and Development in Lahti, Finland;

关键词: Bone Mineral Density;    Celiac Disease;    Celiac Disease Patient;    Celiac Patient;    Gastrointestinal Symptom Rate Scale;   

DOI  :  10.1186/1471-230X-11-136

 received in 2011-09-23, accepted in 2011-12-16,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundThe utility of serologic screening for celiac disease is still debatable. Evidence suggests that the disorder remains undetected even in the older population. It remains obscure whether screening makes good or harm in subjects with long-standing gluten ingestion. We evaluated whether older subjects benefit from active detection and subsequent gluten free dietary treatment of celiac disease.MethodsThirty-five biopsy-proven patients aged over 50 years had been detected by serologic mass screening. We examined the disease history, dietary compliance, symptoms, quality of life and bone mineral density at baseline and 1-2 years after the commencement of a gluten-free diet. Symptoms were evaluated by gastrointestinal symptom rating scale and quality of life by psychological general well-being questionnaires. Small bowel biopsy, serology, laboratory parameters assessing malabsorption, and bone mineral density were investigated.ResultsDietary compliance was good. The patients had initially low mean serum ferritin values indicating subclinical iron deficiency, which was restored by a gluten-free diet. Vitamin B12, vitamin D and erythrocyte folic acid levels increased significantly on diet. Celiac patients had a history of low-energy fractures more often than the background population, and the diet had a beneficial effect on bone mineral density. Alleviation in gastrointestinal symptoms was observed, even though the patients reported no or only subtle symptoms at diagnosis. Quality of life remained unchanged. Of all the cases, two thirds would have been diagnosed even without screening if the family history, fractures or concomitant autoimmune diseases had been taken carefully into account.ConclusionsScreen-detected patients benefited from a gluten-free diet. We encourage a high index of suspicion and active case-finding in celiac disease as an alternative to mass screening in older patients.

【 授权许可】

Unknown   
© Vilppula et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.