Characteristics of Patients Who Avoid Wheat and Gluten in the Absence of Celiac Disease

Celiac.com 02/11/2014 - More and more people are reporting gastrointestinal symptoms that improve when wheat and/or gluten are removed from the diet. There is a diverse group of people who avoid wheat and/or gluten (PWAWGs), and who predominantly self-diagnose prior to presenting for clinical evaluation for celiac disease.

A team of researchers recently set out to compare patients who avoid wheat and/or gluten against patients with celiac disease, and with healthy control subjects. The research team included A. Tavakkoli, S.K. Lewis, C.A. Tennyson, B. Lebwohl, and P.H. Green, all with the Department of Medicine of the Celiac Disease Center at Columbia University in New York, NY.

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The team set out to characterize PWAWGs who were receiving treatment at a tertiary care referral center and to compare them to patients with celiac disease, and with subjects from the National Health and Nutrition examination survey (NHANES). The team conducted a cross-sectional study to evaluate patients seen by four gastroenterologists at a celiac disease referral center. They compared baseline characteristics, laboratory values, and medical comorbidities for these patients against results for celiac disease patients who presented at the same center, as well as for subjects enrolled in NHANES.

The team compared results for eighty-four PWAWGs against results for 585 celiac disease patients and 2,686 NHANES patients. The found that doctors made a total of thirty-two alternative diagnoses in 25 PWAWGs (30%). Diagnoses included small intestinal bacterial overgrowth and fructose/lactose intolerance.

When compared to patients with celiac patients, PWAWGs had similar body mass index (BMI, 23.1 vs. 23.5, p = 0.54) and mean hemoglobin value (13.4 vs. 13.3, p = 0.6). When compared to male and female patients in NHANES, PWAWGS showed lower BMI, folate, and mean hemoglobin values, while both male and female PWAWGs had a lower prevalence of hypertension.

While there are similarities between celiac disease patients and PWAWGs that could arise from shared HLA haplotypes or result from the gluten-free diet, alternative diagnoses are common in these patients. PWAWGs have a similar cardiovascular profile as celiac disease patients in terms of lower BMI and lower prevalence of hypertension.

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