Abstract
A subset of patients with celiac disease (CD) on a gluten-free diet (GFD) reported the persistence of functional gastrointestinal disorders. Foods containing fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) can trigger a broad range of gastrointestinal symptoms in sensitive individuals. We evaluated the effects of a low FODMAP diet (LFD) on gastrointestinal and psychological symptomatology in CD patients. A total of 50 celiac patients on GFDs and with persistence of gastrointestinal symptoms were included. The patients were randomly allocated to one of two dietary groups—one on a low FODMAP GFD (LF-GFD, n = 25) and the other on a regular GFD (R-GFD, n = 25)—for 21 days. Psychological symptomatology and quality of life were evaluated by the Symptom Checklist-90-R (SCL-90) and the Short Form (36) Health Survey (SF-36) questionnaires, respectively. Gastrointestinal symptomatology and general well-being were evaluated by visual analogue scale (VAS) scores. After 21 days, 21 and 23 patients completed the dietary treatment on LF-GFD and R-GFD, respectively. A reduced global SCL-90 index (p < 0.0003) was found in the LF-GFD group but not in the R-GFD one. However, the SF-36 scores did not differ between groups after treatment. The VAS for abdominal pain was much lower, and the VAS for fecal consistency enhanced after treatment in the LF-GFD group. General well-being increased in both groups but with a much higher improvement in the LF-GFD (p = 0.03). A short-term LFD regimen helps to improve the psychological health and gastrointestinal symptomatology with enhanced well-being of CD patients with persisting functional gastrointestinal symptomatology. The long-term clinical effects of LFD in particular subgroups of CD patients need further evaluation.
Highlights
Celiac disease (CD) is an autoimmune multisystem disorder triggered by gluten ingestion [1,2].celiac disease (CD) affects genetically susceptible individuals who are known to possess the Human LeukocyteAntigen HLA DQ2 (90%–95%) or the HLA DQ8 (5%–10%) haplotypes [3]
To date there are no reports showing the potential effect of low FODMAP diet (LFD) on gastrointestinal symptomatology for patients with CD; we have evaluated the role of LFD on treated CD patients with the persistence of functional gastrointestinal disorders
Between December 2015 and December 2017, we studied patients with CD fulfilling the following inclusion criteria: adult age, treated with a gluten-free diet (GFD) for at least one year, with negative plasma tissue transglutaminase values, with IBS-like symptoms and functional gastrointestinal disorders according to the Rome III criteria [22], and with a global well-being score assessed by a visual analogue scale (VAS) of
Summary
Celiac disease (CD) is an autoimmune multisystem disorder triggered by gluten ingestion [1,2].CD affects genetically susceptible individuals who are known to possess the Human LeukocyteAntigen HLA DQ2 (90%–95%) or the HLA DQ8 (5%–10%) haplotypes [3]. A gluten-free diet (GFD) is the current treatment for CD [5]. In this dietary treatment, foods containing gluten, which is a protein found in grains, such as wheat, barley, rye, and triticale, are excluded. Gluten induces small intestine inflammation, and a GFD helps to counteract the clinical signs/symptoms and to prevent complications [6]. This treatment is highly successful, following a strict GFD poses great difficulty to patients in their family, social, and working contexts, deteriorating their quality of life [7] and causing psychological distress [8]
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