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Study Says Not All Patients with Potential Celiac Disease Need Gluten-free Diet


Image: CC--Jeff Turner

Celiac.com 06/10/2016 - Do all patients with potential celiac disease need a gluten-free diet? The transformation of potential celiac disease to full-blown celiac disease has been described in some western clinical studies, but there is no good data on cases in Asia.

Recently, a team of researchers set out to study the short-term histological course of potential celiac disease in Indian patients. The research team included R Kondala, AS Puri, AK Banka, S Sachdeva, and P Sakhuja. They are variously affiliated with the Department of Gastroenterology and the Department of Pathology at Govind Ballabh Pant Hospital, New Delhi, India.

For their study, the team identified prospective patients with potential celiac disease by screening relatives of celiac patients, patients with the diarrheal subtype of irritable bowel syndrome (IBS-D) and patients with iron deficiency anemia (IDA). They conducted endoscopy with duodenal biopsy on patients who tested positive for immunoglobulin A antibodies against tissue transglutaminase (IgA anti-tTG)

Patients a Marsh-0 to Marsh-II lesion on duodenal biopsy, along with positive IgA tTG serology met the definition of celiac disease. The team retested for serology and histology at 6-month and 12 months.

The team diagnosed 23 male and 34 female patients with potential celiac disease. Patients ranged from 4-73 years old, averaging 28.7 years. Of these 57 patients, 28 were identified by screening 192 first-degree relatives of 55 index cases of celiac disease, while the remaining 29 had either IBS-D or IDA. Duodenal biopsy showed Marsh-0, Marsh-I and Marsh-II changes in 28 celiac patients, 27 IBS-D patients, and 2 IDA patients.

After 6 months, 12 patients became seronegative, while the remaining 45 patients continued to be seropositive at the 12-month time point. Only four patients moved to Marsh III status, while progression from Marsh-0 to either Marsh-I or Marsh-II occurred in six patients and one patient, respectively.

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Meanwhile, 14 patients with Marsh-I did show regression to Marsh-0. Of the two patients who were initially Marsh-II, one remained so upon follow up and one showed favorable regression to Marsh-0 status.

This study shows that, even though almost 80% of the patients diagnosed have potential celiac disease continue to remain seropositive for tTG 12 months later, only 7% slipped to Marsh-III over the same time period.

According to this team, these observations do not justify starting a gluten-free diet in all patients with potential celiac disease, in India.

With all due respect to the research team, I wonder what would happen to these patients if they were followed over a greater time span? Would their conditions worsen? Clearly some longer term follow-up of such patients is warranted.

Also, how many such patients would see an even greater regression of their symptoms and Marsh status if they followed a gluten-free diet? This study doesn’t tell us much about the possible benefits of a gluten-free diet in cases of potential celiac disease, just that, absent a gluten-free diet, some patients worsen and some improve.

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