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3. Systematic review: early feeding practices and the risk of coeliac disease. A 2022 update and revision

Author

Szajewska, H., Shamir, R., Strozyk, A., Chmielewska, A., Zalewski, B.M., Auricchio, R., Koletzko, S., Korponay-Szabo, I.R., Mearin, M.L., Meijer, C., Ribes-Koninckx, C., Troncone, R., PreventCD Project Grp, Szajewska, Hania, Shamir, Raanan, Stróżyk, Agata, Chmielewska, Anna, Zalewski, Bartłomiej M, Auricchio, Renata, Koletzko, Sibylle, Korponay-Szabo, Ilma R, Mearin, M Luisa, Meijer, Caroline, Ribes-Koninckx, Carmen, and Troncone, Riccardo

Subjects
Celiac Disease, Hepatology, Gastroenterology, Humans, Pharmacology (medical), Evidence Gaps
Abstract

Background: The effects of early feeding practices on the risk of coeliac disease (CD) remain debated. Aims: To update evidence on these practices on the risk of CD and/or CD-related autoimmunity (CDA), defined as anti-transglutaminase or anti-endomysial antibody positivity. Methods: We searched MEDLINE, EMBASE and the Cochrane Library to May 2022 for randomised controlled trials (RCTs) and observational studies. Results: We included 36 publications (30 studies). In the population at genetic risk of developing CD (HLA DQ2/DQ8-positive), exclusive or any breastfeeding and longer breastfeeding duration did not reduce the risk of developing CD/CDA during childhood. While a meta-analysis of four case–control studies showed a decreased risk for CD when gluten was introduced during breastfeeding, this was not shown in RCTs and cohort studies. Age at gluten introduction was not associated with cumulative CD/CDA risk, although two RCTs suggested that earlier gluten introduction was associated with earlier CDA appearance. Evidence from six observational studies suggests that consumption of a higher amount of gluten at weaning and/or thereafter may increase CD risk. There is insufficient evidence to determine the amount of gluten associated with an increased CD/CDA risk. Regarding whether infant feeding practices modulate the risk conferred by different HLA genotypes results were inconsistent. Conclusions: For the population at genetic risk of CD, breastfeeding and age at gluten introduction have no effect on its cumulative incidence during childhood. There is some evidence for an effect of the amount of gluten consumed at weaning and/or thereafter on CD/CDA risk.

Published
2022

4. ESPGHAN position paper on management and follow-up of children and adolescents with celiac disease

Author

Mearin, M.L., Agardh, D., Antunes, H., Al-Toma, A., Auricchio, R., Castillejo, G., Catassi, C., Ciacci, C., Discepolo, V., Dolinsek, J., Donat, E., Gillett, P., Guandalini, S., DMSc, S.H.M., Md, S.K., Koltai, T., Korponay-Szabo, I.R., Kurppa, K., Lionetti, E., Marild, K., Ojinaga, E.M., Meijer, C., Monachesi, C., Polanco, I., Popp, A., Roca, M., Rodriguez-Herrera, A., Shamir, R., Stordal, K., Troncone, R., Valitutti, F., Vreugdenhil, A., Wessels, M., Whiting, P., ESPGHAN Special Interest Grp Celia, Kindergeneeskunde, MUMC+: MA Medische Staf Kindergeneeskunde (9), RS: NUTRIM - R1 - Obesity, diabetes and cardiovascular health, Mearin, Maria Luisa, Agardh, Daniel, Antunes, Henedina, Al-Toma, Abdul, Auricchio, Renata, Castillejo, Gemma, Catassi, Carlo, Ciacci, Carolina, Discepolo, Valentina, Dolinsek, Jernej, Donat, Ester, Gillett, Peter, Guandalini, Steffano, Husby Md DMSc, Steffen, Koletzko Md, Sibylle, Koltai, Tunde, Korponay-Szabó, Ilma Rita, Kurppa, Kalle, Lionetti, Elena, Mårild, Karl, Martinez Ojinaga, Eva, Meijer, Caroline, Monachesi, Chiara, Polanco, Isabel, Popp, Alina, Roca, Maria, Rodriguez-Herrera, Alfonso, Shamir, Raanan, Stordal, Ketil, Troncone, Riccardo, Valitutti, Francesco, Vreugdenhil, Anita, Wessels, Margreet, and Whiting, Penny

Subjects
MUCOSAL RECOVERY, Adolescent, Glutens, LARAZOTIDE ACETATE, position paper European Society of Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN), Gastroenterology, EUROPEAN-SOCIETY, Diet, Gluten-Free, DOUBLE-BLIND, children and adolescents, QUALITY-OF-LIFE, HEPATITIS-B-VACCINE, THYROID-DISEASE, Pediatrics, Perinatology and Child Health, Quality of Life, follow-up, Humans, IMMUNE-RESPONSE, children and adolescent, BONE-MINERAL DENSITY, Child, GLUTEN-FREE DIET, celiac disease, Follow-Up Studies
Abstract

There is a need for consensus on the recommendations for follow-up of children and adolescents with celiac disease. Objectives: To gather the current evidence and to offer recommendations for follow-up and management. Methods: The Special Interest Group on Celiac Diseases of the European Society of Paediatric Gastroenterology Hepatology and Nutrition formulated ten questions considered to be essential for follow-up care. A literature search (January 2010-March 2020) was performed in PubMed or Medline. Relevant publications were identified and potentially eligible studies were assessed. Statements and recommendations were developed and discussed by all coauthors. Recommendations were voted upon: joint agreement was set as at least 85%. Results: Publications (n = 2775) were identified and 164 were included. Using evidence or expert opinion, 37 recommendations were formulated on: The need to perform follow-up, its frequency and what should be assessed, how to assess adherence to the gluten-free diet, when to expect catch-up growth, how to treat anemia, how to approach persistent high serum levels of antibodies against tissue-transglutaminase, the indication to perform biopsies, assessment of quality of life, management of children with unclear diagnosis for which a gluten-challenge is indicated, children with associated type 1 diabetes or IgA deficiency, cases of potential celiac disease, which professionals should perform follow-up, how to improve the communication to patients and their parents/caregivers and transition from pediatric to adult health care. Conclusions: We offer recommendations to improve follow-up of children and adolescents with celiac disease and highlight gaps that should be investigated to further improve management.

Published
2022

5. Circulating miRNAs as Potential Biomarkers for Celiac Disease Development

Author

Tan, I, Coutinho de Almeida, R, Modderman, R, Stachurska, A, Dekens, J, Barisani, D, Meijer, C, Roca, M, Martinez-Ojinaga, E, Shamir, R, Auricchio, R, Korponay-Szabo, I, Castillejo, G, Szajewska, H, Koletzko, S, Zhernakova, A, Kumar, V, Li, Y, Visschedijk, M, Weersma, R, Troncone, R, Mearin, M, Wijmenga, C, Jonkers, I, Withoff, S, Tan I. L., Coutinho de Almeida R., Modderman R., Stachurska A., Dekens J., Barisani D., Meijer C. R., Roca M., Martinez-Ojinaga E., Shamir R., Auricchio R., Korponay-Szabo I. R., Castillejo G., Szajewska H., Koletzko S., Zhernakova A., Kumar V., Li Y., Visschedijk M. C., Weersma R. K., Troncone R., Mearin M. L., Wijmenga C., Jonkers I., Withoff S., Tan, I, Coutinho de Almeida, R, Modderman, R, Stachurska, A, Dekens, J, Barisani, D, Meijer, C, Roca, M, Martinez-Ojinaga, E, Shamir, R, Auricchio, R, Korponay-Szabo, I, Castillejo, G, Szajewska, H, Koletzko, S, Zhernakova, A, Kumar, V, Li, Y, Visschedijk, M, Weersma, R, Troncone, R, Mearin, M, Wijmenga, C, Jonkers, I, Withoff, S, Tan I. L., Coutinho de Almeida R., Modderman R., Stachurska A., Dekens J., Barisani D., Meijer C. R., Roca M., Martinez-Ojinaga E., Shamir R., Auricchio R., Korponay-Szabo I. R., Castillejo G., Szajewska H., Koletzko S., Zhernakova A., Kumar V., Li Y., Visschedijk M. C., Weersma R. K., Troncone R., Mearin M. L., Wijmenga C., Jonkers I., and Withoff S.

Abstract

Background & Aims: Celiac disease (CeD), an immune-mediated disease with enteropathy triggered by gluten, affects ~1% of the general European population. Currently, there are no biomarkers to predict CeD development. MicroRNAs (miRNAs) are short RNAs involved in post-transcriptional gene regulation, and certain disease- and stage-specific miRNA profiles have been found previously. We aimed to investigate whether circulating miRNAs can predict the development of CeD. Methods: Using next-generation miRNA-sequencing, we determined miRNAs in >200 serum samples from 53 participants of the PreventCD study, of whom 33 developed CeD during follow-up. Following study inclusion at 3 months of age, samples were drawn at predefined ages, diagnosis (first anti-transglutaminase antibody (TGA) positivity or diagnostic biopsy) and after the start of a gluten-free diet (GFD). This allowed identification of circulating miRNAs that are deregulated before TGA positivity. For validation of the biomarkers for CeD and GFD response, two additional cohorts were included in subsequent meta-analyses. Additionally, miRNAs were measured in duodenal biopsies in a case-control cohort. Results: 53 circulating miRNAs were increased (27) or decreased (26) in CeD versus controls. We assessed specific trends in these individual miRNAs in the PreventCD cohort by grouping the pre-diagnostic samples of the CeD patients (all had negative TGA) by how close to seroconversion (first sample positive TGA) the samples were taken. 8/53 miRNAs differed significantly between controls and samples taken <1 year before TGA positivity: miR-21-3p, miR-374a-5p, 144-3p, miR-500a-3p, miR-486-3p let-7d-3p, let-7e-5p and miR-3605-3p. 6/26 downregulated miRNAs reconstituted upon GFD, including miR-150-5p/-3p, whereas no upregulated miRNAs were downregulated upon GFD. 15/53 biomarker candidates also differed between CeD biopsies and controls, with a concordant direction, indicating that these circulating miRNAs migh

Published
2021

6. Prediction Models for Celiac Disease Development in Children From High-Risk Families: Data From the PreventCD Cohort

Author

Meijer, C.R., Auricchio, R., Putter, H., Castillejo, G., Crespo, P., Gyimesi, J., Hartman, C., Kolacek, S., Koletzko, S., Korponay-Szabo, I., Ojinaga, E.M., Polanco, I., Ribes-Koninckx, C., Shamir, R., Szajewska, H., Troncone, R., Villanacci, V., Werkstetter, K., Mearin, M.L., Meijer, Caroline R, Auricchio, Renata, Putter, Hein, Castillejo, Gemma, Crespo, Paula, Gyimesi, Judit, Hartman, Corina, Kolacek, Sanja, Koletzko, Sibylle, Korponay-Szabo, Ilma, Ojinaga, Eva Martinez, Polanco, Isabel, Ribes-Koninckx, Carmen, Shamir, Raanan, Szajewska, Hania, Troncone, Riccardo, Villanacci, Vincenzo, Werkstetter, Katharina, and Mearin, M Luisa

Subjects
Hepatology, Gastroenterology, high risk birth cohort, prediction model, Cohort Studies, Celiac Disease, Prediction Models, Risk Factors, Prediction Application, Child, Preschool, Humans, Female, Genetic Predisposition to Disease, Prospective Studies, High-Risk Birth Cohort, Child, Individualized Screening Advice
Abstract

BACKGROUND AND AIMS: Screening for celiac disease (CD) is recommended in children with affected first-degree relatives (FDR). However, the frequency of screening and at what age remain unknown. The aims of this study were to detect variables influencing the risk of CD development and develop and validate clinical prediction models to provide individualized screening advice. METHODS: We analyzed prospective data from the 10 years of follow-up of the PreventCD-birth cohort involving 944 genetically predisposed children with CD-FDR. Variables significantly influencing the CD risk were combined to determine a risk score. Landmark analyses were performed at different ages. Prediction models were created using multivariable Cox proportional hazards regression analyses, backward elimination, and Harrell's c-index for discrimination. Validation was done using data from the independent NeoCel cohort. RESULTS: In March 2019, the median follow-up was 8.3 years (22 days-12.0 years); 135/944 children developed CD (mean age, 4.3 years [range, 1.1-11.4]). CD developed significantly more often in girls (P = .005) and in Human Leukocyte Antigen (HLA)-DQ2 homozygous individuals (8-year cumulative incidence rate of 35.4% vs maximum of the other HLA-risk groups 18.2% [P < .001]). The effect of homozygosity DR3-DQ2/DR7-DQ2 on CD development was only present in girls (interaction P = .04). The prediction models showed good fit in the validation cohort (Cox regression 0.81 [0.54]). To calculate a personalized risk of CD development and provide screening advice, we designed the Prediction application https://hputter.shinyapps.io/preventcd/. CONCLUSION: Children with CD-FDR develop CD early in life, and their risk depends on gender, age and HLA-DQ, which are all factors that are important for sound screening advice. These children should be screened early in life, including HLA-DQ2/8-typing, and if genetically predisposed to CD, they should get further personalized screening advice using our Prediction application. TRIAL REGISTRATION NUMBER: ISRCTN74582487.

Published
2022

7. ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease

Author

Mearin, M L, Agardh, D, Antunes, H, Al-Toma, A, Auricchio, R, Castillejo, G, Catassi, C, Ciacci, C, Discepolo, V, Dolinsek, J, Donat, E, Gillett, P, Guandalini, S, Husby, S, Koletzko, S, Koltai, T, Korponay-Szabó, I R, Kurppa, K, Lionetti, E, Mårild, K, Martinez Ojinaga, E, Meijer, C, Monachesi, C, Polanco, I, Popp, A, Roca, M, Rodriguez-Herrera, A, Shamir, R, Stordal, K, Troncone, R, Valitutti, F, Vreugdenhil, A, Wessels, M, Whiting, P, ESPGHAN Special Interest Group on Celiac Disease, Mearin, M L, Agardh, D, Antunes, H, Al-Toma, A, Auricchio, R, Castillejo, G, Catassi, C, Ciacci, C, Discepolo, V, Dolinsek, J, Donat, E, Gillett, P, Guandalini, S, Husby, S, Koletzko, S, Koltai, T, Korponay-Szabó, I R, Kurppa, K, Lionetti, E, Mårild, K, Martinez Ojinaga, E, Meijer, C, Monachesi, C, Polanco, I, Popp, A, Roca, M, Rodriguez-Herrera, A, Shamir, R, Stordal, K, Troncone, R, Valitutti, F, Vreugdenhil, A, Wessels, M, Whiting, P, and ESPGHAN Special Interest Group on Celiac Disease

Abstract

AIM: To gather the current evidence and to offer recommendations for follow-up and management.METHODS: The Special Interest Group on Coeliac Diseases of the European Society of Paediatric Gastroenterology Hepatology and Nutrition formulated ten questions considered to be essential for follow-up care. A literature search (January 2010 - March 2020) was performed in PubMed or Medline. Relevant publications were identified and potentially eligible studies were assessed. Statements and recommendations were developed and discussed by all co-authors. Recommendations were voted upon: joint agreement was set as at least 85%.RESULTS: Publications (n=2775) were identified and 164 were included. Using evidence and/or expert opinion, 37 recommendations were formulated on: The need to perform follow-up, its frequency and what should be assessed, how to assess adherence to the gluten-free diet, when to expect catch-up growth, how to treat anaemia, how to approach persistent high serum levels of antibodies against tissue-transglutaminase, the indication to perform biopsies, assessment of quality of life, management of children with unclear diagnosis for which a gluten challenge is indicated, children with associated type 1 diabetes or IgA deficiency, cases of potential coeliac disease, which professionals should perform follow-up, how to improve the communication to patients and their parents/caregivers and transition from paediatric to adult health-care.CONCLUSIONS: We offer recommendations to improve follow-up of children and adolescents with coeliac disease and highlight gaps that should be investigated to further improve management.

Published
2022

8. Erratum: Author Correction: Constitutive alterations in vesicular trafficking increase the sensitivity of cells from celiac disease patients to gliadin (Communications biology (2019) 2 (190))

Author

Lania G., Nanayakkara M., Maglio M., Auricchio R., Porpora M., Conte M., De Matteis M. A., Rizzo R., Luini A., Discepolo V., Troncone R., Auricchio S., Barone M. V., Lania, G., Nanayakkara, M., Maglio, M., Auricchio, R., Porpora, M., Conte, M., De Matteis, M. A., Rizzo, R., Luini, A., Discepolo, V., Troncone, R., Auricchio, S., and Barone, M. V.

Abstract

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Published
2020

12. Circulating miRNAs as Potential Biomarkers for Celiac Disease Development

Author

Universitat Rovira i Virgili, Tan IL; Coutinho de Almeida R; Modderman R; Stachurska A; Dekens J; Barisani D; Meijer CR; Roca M; Martinez-Ojinaga E; Shamir R; Auricchio R; Korponay-Szabó IR; Castillejo G; Szajewska H; Koletzko S; Zhernakova A; Kumar V; Li Y; Visschedijk MC; Weersma RK; Troncone R; Mearin ML; Wijmenga C; Jonkers I; Withoff S, Universitat Rovira i Virgili, and Tan IL; Coutinho de Almeida R; Modderman R; Stachurska A; Dekens J; Barisani D; Meijer CR; Roca M; Martinez-Ojinaga E; Shamir R; Auricchio R; Korponay-Szabó IR; Castillejo G; Szajewska H; Koletzko S; Zhernakova A; Kumar V; Li Y; Visschedijk MC; Weersma RK; Troncone R; Mearin ML; Wijmenga C; Jonkers I; Withoff S

Abstract

Background & Aims: Celiac disease (CeD), an immune-mediated disease with enteropathy triggered by gluten, affects ~1% of the general European population. Currently, there are no biomarkers to predict CeD development. MicroRNAs (miRNAs) are short RNAs involved in post-transcriptional gene regulation, and certain disease- and stage-specific miRNA profiles have been found previously. We aimed to investigate whether circulating miRNAs can predict the development of CeD. Methods: Using next-generation miRNA-sequencing, we determined miRNAs in >200 serum samples from 53 participants of the PreventCD study, of whom 33 developed CeD during follow-up. Following study inclusion at 3 months of age, samples were drawn at predefined ages, diagnosis (first anti-transglutaminase antibody (TGA) positivity or diagnostic biopsy) and after the start of a gluten-free diet (GFD). This allowed identification of circulating miRNAs that are deregulated before TGA positivity. For validation of the biomarkers for CeD and GFD response, two additional cohorts were included in subsequent meta-analyses. Additionally, miRNAs were measured in duodenal biopsies in a case-control cohort. Results: 53 circulating miRNAs were increased (27) or decreased (26) in CeD versus controls. We assessed specific trends in these individual miRNAs in the PreventCD cohort by grouping the pre-diagnostic samples of the CeD patients (all had negative TGA) by how close to seroconversion (first sample positive TGA) the samples were taken. 8/53 miRNAs differed significantly between controls and samples taken <1 year before TGA positivity: miR-21-3p, miR-374a-5p, 144-3p, miR-500a-3p, miR-486-3p let-7d-3p, let-7e-5p and miR-3605-3p. 6/26 downregulated miRNAs reconstituted upon GFD, including miR-150-5p/-3p, whereas no upregula

Published
2021

15. Prevalence of atopy in children with chronic constipation

Author

Simeone, D., Miele, E., Boccia, G., Marino, A., Troncone, R., and Staiano, A.

Subjects
Food allergy in children -- Distribution, Food allergy in children -- Research, Constipation -- Demographic aspects, Constipation -- Distribution, Constipation -- Research, Milk allergy -- Research, Company distribution practices
Published
2008

16. European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020

Author

Husby S, Koletzko S, Korponay-Szabó I, Kurppa K, Mearin ML, Ribes-Koninckx C, Shamir R, Troncone R, Auricchio R, Castillejo G, Christensen R, Dolinsek J, Gillett P, Hróbjartsson A, Koltai T, Maki M, Nielsen SM, Popp A, Bucharest, Størdal K, Werkstetter K, and Wessels M

Subjects
meta-analysis, diagnostic tests, children and adolescents, coeliac disease
Abstract

The ESPGHAN 2012 coeliac disease (CD) diagnostic guidelines aimed to guide physicians in accurately diagnosing CD and permit omission of duodenal biopsies in selected cases. Here, an updated and expanded evidence-based guideline is presented.

Published
2020

24. An immunodominant DQ8 restricted gliadin peptide activates small intestinal immune response in in vitro cultured mucosa from HLA-DQ8 positive but not HLA-DQ8 negative coeliac patients. (Small Intestine)

Author

Mazzarella, G., Maglio, M., Paparo, F., Nardone, G., Stefanile, R., Greco, L., Wal, Y. van de, Kooy, Y., Koning, F., Auricchio, S., and Troncone, R.

Subjects
Celiac disease -- Research -- Health aspects, HLA class II antigens -- Health aspects -- Research, Health
Abstract

Background: Studies on intestinal T cell clones from the mucosa of patients with coeliac disease have led to the identification of immunogenic gliadin epitopes. One is HLA-DQ8 restricted, its recognition [...]

Published
2003

25. Anti-tissue transglutaminase antibodies from coeliac patients inhibit transglutaminase activity both in vitro and in situ. (Coeliac Disease)

Author

Esposito, C., Paparo, F., Caputo, I., Rossi, M., Maglio, M., Sblattero, D., Not, T., Porta, R., Auricchio, S., Marzari, R., and Troncone, R.

Subjects
Transglutaminases -- Physiological aspects, Celiac disease -- Physiological aspects, Viral antibodies -- Physiological aspects, Immunoglobulin A -- Physiological aspects, Immunoglobulin G -- Physiological aspects, Antibodies -- Physiological aspects, Health
Abstract

Background and aims: Coeliac disease (CD) is a multifactorial disarder which has an autoimmune camponent characterised by the occurrence of disease specific autoreactive antibodies against the enzyme tissue transglutaminase (tTG). [...]

Published
2002

26. Interleukin 18 and associated markers of T helper cell type 1 activity in Coeliac disease. (Coeliac Disease)

Author

Salvati, V.M., MacDonald, T.T., Bajaj-Elliott, M., Borrelli, M., Staiano, A., Auricchio, S., Troncone, R., and Monteleone, G.

Subjects
Celiac disease -- Research, Interleukins -- Physiological aspects -- Research, Health, Physiological aspects, Research
Abstract

Background: Coeliac disease (CD) is caused by a T helper cell type 1 (Th1) response in the small intestinal mucosa to dietary gluten. Paradoxically, interleukin (IL)-12, the major Th1 inducing [...]

Published
2002

40. Intractable diarrhoea in infancy in the 1990s: A survey in Italy

Author

Ventura, Alessandro, Dragovich, Dana, Ansaldi, N., Balli, F., Banchini, G., Bascietto, F., Bianchi, C., Bonamico, M., Calvani, M., Cataldo, F., Catassi, C., Light, C., Ciampolini, M., Dore, A., DeSeta, L., Faraguha, D., Ferrari, R., Fontana, M., Giunta, A. M., Guandalini, S., Guarino, A., Iacono, G., Lambertini, A., Lazzari, R., Mastella, G., Miano, A., Patanè, R., Pesce, F., Roggero, P., Rutigliano, V., Scotta, S., Tedesch, A., Troncone, R., Ugazio, A., and Zancan, L.

Published
1995
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50. Compliance of adolescents with coeliac disease with a gluten free diet

Author

Mayer, M., Greco, L., Troncone, R., Auricchio, S., and Marsh, M. N.

Subjects
Patient compliance -- Health aspects, Celiac disease -- Care and treatment, Gluten-free diet -- Physiological aspects, Patient compliance -- Evaluation, Health
Abstract

Coeliac disease, an immune inflammatory disorder of the gastrointestinal tract characterized by diarrhea, malnutrition, gastrointestinal bleeding, and low blood calcium levels, is frequently treated by prescribing a special diet free from gluten (a vegetable protein found in wheat). Often, adherence to this diet must be maintained throughout a patient's entire life. Owing to the somewhat unpalatable nature of the gluten-free diet, appreciable problems with patient compliance have been reported. Non-compliance among teenagers has been documented to be as high as 50 percent; actual non-compliance rates may be even higher if microscopic abnormalities in intestinal anatomy are accurate markers for surreptitious dietary intake of gluten. To further document the rate of compliance and the effect of non-compliance to a gluten-free diet in adolescents, a study was carried out involving 123 patients diagnosed as having celiac disease within the first three years of life who could be followed-up for at least 10 years. Biopsy specimens were obtained from 36 of the patients. Dietary analysis indicated that 65 percent of the study population was adhering strictly to the diet as prescribed; 11.4 percent occasionally went off the diet, and 23.6 percent did not restrict gluten intake. Clinical symptoms, such as bleeding and diarrhea, were more common among patients who did not restrict gluten intake, but there were no differences between strict adherents to the diet and those who allowed occasional lapses. Patients who did not regulate gluten intake had higher levels of antigliadin antibodies (antibodies against a common wheat protein) than either of the two restricted-gluten groups; and both unrestricted and partially restricted patients had pathological microscopic changes in intestinal structure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1991

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