A gluten-free diet benefited asymptomatic patients with serologic markers for celiac disease in a prospective randomized study.
The findings support active screening for celiac disease in patients at risk for the disease, even if symptoms aren’t present, according to Dr. Kalle Kurppa of the University of Tampere (Finland) and Tampere University Hospital.
The report is in the September issue of Gastroenterology (doi.org/10.1053/j.gastro.2014.05.003).
After 1 year, 20 adults with endomysial antibodies (EmA) who were randomized to a gluten-free diet (GFD) experienced significant increases in mean mucosal villous height:crypt depth values, significantly decreased levels of celiac-associated antibodies, and greater improvement in gastrointestinal symptoms, compared with 20 patients randomized to a gluten-containing diet. For example, mean small bowel mucosal villous height:crypt depth increased from 1.0 to about 2.8 in the GFD group, and from 0.8 to about 0.9 in the gluten-containing diet group, and total Gastrointestinal Symptoms Rating Scale scores improved significantly (–0.4 difference in mean change from baseline, favoring a GFD), as did individual scores for diarrhea, indigestion, and reflux in the GFD group, wrote Dr. Kurppa and colleagues.
The patients in the GFD group also experienced reduced indigestion, reflux, and anxiety, and better health as measured by Psychological, General Health, and Well-Being scores and most Short Form–36 scores, they noted.
Only social function scores on the Short Form–36 improved more in the gluten-containing diet group (–8.3 difference in mean change from baseline, favoring a gluten-containing diet).
The subjects in both groups had a median age of 42 years, and the groups were similar with respect to sex, medical history, and associated conditions.
No differences were seen between the two groups with respect to laboratory test results, bone mineral density, or body composition, and the subjects in the GFD group did not report any negative effects or reactions to the diet. After trial completion, 92% reported adherence to the gluten-free diet, and 85% said they expected to remain on the diet, the investigators noted.
Because celiac disease affects 1%-2% of the population, but is difficult to detect because of clinical heterogeneity, wide-scale screening with noninvasive serologic testing is frequently suggested.
"However, the only current treatment of the condition, a lifelong strict gluten-free diet, is restrictive and difficult to maintain and thus the positive effects of the screening are not straightforward," the investigators noted, adding that results of prior studies exploring the benefits of a gluten-free diet have been inconsistent – particularly for asymptomatic patients.
Another problem is that wide-scale screening often detects asymptomatic seropositive subjects with only mild enteropathy or even normal small-bowel mucosa, and it is unclear whether these individuals actually suffer from a true gluten-induced clinical disease, they said.
"The results of this randomized study showed that screen-detected and even apparently asymptomatic EmA-positive patients benefit from a gluten-free diet as measured by extensive clinical, serologic, and histologic parameters," the investigators said.
The fact that subjects who considered themselves asymptomatic experienced improvement in the current study suggests that "the patients may in fact have accepted mild symptoms as normal and recognized them as abnormal only later when on the diet," they said.
The findings support active screening for celiac disease in patients at risk, but the potential consequences of screening – particularly on social functioning, should be considered on an individual basis, they said, adding that prospective studies are needed "to unravel whether screen-detected seropositive subjects with completely normal small-bowel mucosal histology should be treated."
This study was supported by the Academy of Finland Research Council for Health, the Competitive Research Funding of the Pirkanmaa Hospital District, the Sigrid Juselius Foundation, the Finnish Foundation for Research, the Yrjö Jahnsson Foundation, the Foundation for Pediatric Research, and the Finnish Celiac Society. The authors reported having no disclosures.