Abstract
Experience suggests that many celiac patients suffer from persistent symptoms despite a long-term gluten-free diet (GFD). We investigated the prevalence and severity of these symptoms in patients with variable duration of GFD. Altogether, 856 patients were classified into untreated (n = 128), short-term GFD (1–2 years, n = 93) and long-term GFD (≥3 years, n = 635) groups. Analyses were made of clinical and histological data and dietary adherence. Symptoms were evaluated by the validated GSRS questionnaire. One-hundred-sixty healthy subjects comprised the control group. Further, the severity of symptoms was compared with that in peptic ulcer, reflux disease, inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). Altogether, 93% of the short-term and 94% of the long-term treated patients had a strict GFD and recovered mucosa. Untreated patients had more diarrhea, indigestion and abdominal pain than those on GFD and controls. There were no differences in symptoms between the short- and long-term GFD groups, but both yielded poorer GSRS total score than controls (p = 0.03 and p = 0.05, respectively). Furthermore, patients treated 1–2 years had more diarrhea (p = 0.03) and those treated >10 years more reflux (p = 0.04) than controls. Long-term treated celiac patients showed relatively mild symptoms compared with other gastrointestinal diseases. Based on our results, good response to GFD sustained in long-term follow-up, but not all patients reach the level of healthy individuals.
Highlights
The only current treatment for celiac disease is a life-long gluten-free diet
There were no significant differences between the celiac disease groups in either gender, median age at time of study, clinical presentation at diagnosis or celiac disease in the family (Table 1)
Among patients on a gluten-free diet the long-term treated cohort contained lower percentage of endomysial antibody (EmA)-positive subjects than the short-term treated, while there were no differences in self-reported dietary adherence or villous height crypt depth ratio (VH/CrD)
Summary
Commencement of a strict diet usually results in prompt relief of clinical symptoms, while recovery of small-bowel mucosal damage may take even years [1,2]. There is some evidence that after the initial enthusiasm has faded, many patients experience ongoing symptoms while maintaining an apparently strict gluten-free diet [4,5,6,7]. Such persistence of symptoms despite burdensome dietary restriction is frustrating and may even predispose to poor dietary adherence and Nutrients 2016, 8, 429; doi:10.3390/nu8070429 www.mdpi.com/journal/nutrients
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