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    Does a Gluten-free Diet Help Asymptomatic Patients with Serologic Markers of Celiac Disease?

    Jefferson Adams

    Celiac.com 10/15/2014 - A team of researchers recently set out to assess the benefits of a gluten-free diet for people whose blood screens show markers for celiac disease, but who show no physical symptoms. Specifically, they investigated whether screen-detected and apparently asymptomatic adults with endomysial antibodies (EmA) benefit from a gluten-free diet.

    Photo: Mira HirismäkiThe research team included K. Kurppa, A. Paavola, P. Collin, H. Sievänen, K. Laurila, H. Huhtala, P. Saavalainen, M. Mäki, and K. Kaukinen. They are variously associated with the Tampere Center for Child Health Research, the Tampere School of Health Sciences of the University of Tampere and Tampere University Hospital, the Department of Gastroenterology and Alimentary Tract Surgery at Tampere University Hospital and School of Medicine, University of Tampere, the UKK Institute in Tampere, Finland, the Research Program Unit of the Immunobiology and Haartman Institute at the Department of Medical Genetics of the University of Helsinki in Helsinki, Finland, and the Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland and Seinäjoki Central Hospital, Seinäjoki, Finland.

    For their study, they conducted a prospective trial of 3031 individuals at risk for celiac disease based on screens for EmA. They found 40 of 148 seropositive individuals who fulfilled inclusion criteria. They randomly assigned the 40 patients to groups receiving either a gluten-free diet, or a gluten-containing diet.

    They then evaluated ratios of small-bowel mucosal villous height:crypt depth, serology and laboratory test results, gastrointestinal symptom scores, physiologic well-being, perception of health by a visual analog scale, bone mineral density, and body composition at baseline and after 1 year. From that point on, they switched the group on the gluten-containing diet to a gluten-free diet, evaluated them a third time. Patients in the first gluten-free diet group remained on that diet.

    After 1 year on the gluten-free diet, the mean mucosal villous height:crypt depth values increased (P < .001), levels of celiac-associated antibodies decreased (P < .003), and gastrointestinal symptoms improved compared to patients on gluten-containing diets (P = .003).

    The gluten-free diet group showed less indigestion (P = .006), reflux (P = .05), and anxiety (P = .025), and better overall health, based on the visual analog scale (P = .017), compared gluten-containing diet group.

    Only social function scores improved more in the gluten-containing diet group than in the gluten-free diet group (P = .031). There were no differences between groups in terms of lab test results, bone mineral density, or body composition.

    Most measured parameters improved when patients in the gluten-containing diet group were placed on gluten-free diets.

    No subjects considered their experience to be negative and most expected to continue eating gluten-free.

    The results show that a gluten-free diet benefits asymptomatic EmA-positive patients, and show the benefits of actively screening patients at risk for celiac disease.

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    The abstract appears to be inconsistent. If all patients were asymptomatic to begin with neither groups should show improvement in well being such as gastric symptoms.

    It appears to me that the study included patients who were in fact symptomatic but were not aware how symptomatic they were until they went on gluten-free diet. This is common. Also some of the patients had obvious changes in the mucosa, which improved with gluten-free diet. These patients obviously benefit from a gluten-free diet.

    From this abstract I question if the study has some flaws and if gluten-free diet is indicated based on the results particularly if lab tests stay the same regardless of diet.

     

    If the my conclusions are wrong, I would welcome the opportunity to see further details of the study.

     

    On a different note, I am aware of a study that was posted on this site, which I found to be conducted in a better way and the researchers came to the conclusion that it is questionable if gluten-free diet is in fact beneficial for asymptomatic patients. In fact some patients (females more than males) serology improved even with gluten containing diet.

    We have to consider that gluten-free diet has social risks and financial implications therefore I think that it is important to continue studying this subject.

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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, and science. He previously served as Health News Examiner for Examiner.com, and provided health and medical content for Sharecare.com.

    Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book Dangerous Grains by James Braly, MD and Ron Hoggan, MA.

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