Clinical benefit of gluten-free diet in screen-detected older celiac disease patients

Department of Neurology, Päijät-Häme Central Hospital, Lahti, Finland.
BMC Gastroenterology (Impact Factor: 2.11). 12/2011; 11:136. DOI: 10.1186/1471-230X-11-136
Source: PubMed

ABSTRACT The utility of serologic screening for celiac disease is still debatable. Evidence suggests that the disorder remains undetected even in the older population. It remains obscure whether screening makes good or harm in subjects with long-standing gluten ingestion. We evaluated whether older subjects benefit from active detection and subsequent gluten free dietary treatment of celiac disease.
Thirty-five biopsy-proven patients aged over 50 years had been detected by serologic mass screening. We examined the disease history, dietary compliance, symptoms, quality of life and bone mineral density at baseline and 1-2 years after the commencement of a gluten-free diet. Symptoms were evaluated by gastrointestinal symptom rating scale and quality of life by psychological general well-being questionnaires. Small bowel biopsy, serology, laboratory parameters assessing malabsorption, and bone mineral density were investigated.
Dietary compliance was good. The patients had initially low mean serum ferritin values indicating subclinical iron deficiency, which was restored by a gluten-free diet. Vitamin B12, vitamin D and erythrocyte folic acid levels increased significantly on diet. Celiac patients had a history of low-energy fractures more often than the background population, and the diet had a beneficial effect on bone mineral density. Alleviation in gastrointestinal symptoms was observed, even though the patients reported no or only subtle symptoms at diagnosis. Quality of life remained unchanged. Of all the cases, two thirds would have been diagnosed even without screening if the family history, fractures or concomitant autoimmune diseases had been taken carefully into account.
Screen-detected patients benefited from a gluten-free diet. We encourage a high index of suspicion and active case-finding in celiac disease as an alternative to mass screening in older patients.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Context: Coeliac disease, an autoimmune disease induced by dietary gluten, is associated with metabolic bone disorders, such as low bone mineral density. However, it is unclear whether this translates into an association between coeliac disease and such hard clinical outcomes as bone fractures. Objective: To systematically review and pool the evidence for the relationship of coeliac disease with prevalence and incidence of bone fractures. Data sources: We systematically searched Pubmed, Scopus, Web of Science and Cochrane Library in January 2014 for studies of coeliac disease and bone fractures. Study selection: Observational studies of any design, in which bone fracture outcomes were compared in individuals with and without coeliac disease were included. Data extraction: Two investigators independently extracted results from eligible studies. Data synthesis: In the meta-analyses of case-control and cross-sectional studies, bone fractures were almost twice as common in individuals with a clinically diagnosed coeliac disease as in those without the disease. In the meta-analyses of prospective studies, coeliac disease at baseline was associated with a 30% increase (95% CI: 1.14, 1.50) in the risk of any fracture and a 69% increase in the risk of hip fracture (95% CI: 1.10, 2.59). The two studies of unrecognised coeliac disease (elevated circulating concentrations of coeliac disease-specific autoantibodies but no coeliac disease diagnosis) had contradicting findings. Conclusion: Our findings suggest that clinically diagnosed coeliac disease and bone fractures co-occur and that coeliac disease was associated with an increased risk of hip fractures as well as fractures in general. Further research would be needed to determine whether unrecognised coeliac disease is associated with the risk of bone fractures.
    Journal of Clinical Endocrinology &amp Metabolism 10/2014; 100(1):jc20141858. DOI:10.1210/jc.2014-1858 · 6.31 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: IntroductionThe impact of coeliac disease autoimmunity on bone health is unclear. We investigated the associations of seropositivity for tissue transglutaminase antibodies (tTGA) and endomysial antibodies (EMA) with incident hip fractures using data from a prospective cohort study, Mini-Finland Health Survey.Methods Baseline serum samples, taken in 1978-80, were tested for tTGA and EMA. Incident hip fractures up to the year 2011 were ascertained from a national hospitalisation register. Associations between seropositivity and hip fractures were modelled using Cox proportional hazards regression adjusted for age, sex, body mass index, vitamin D, gamma-glutamyl transferase, smoking and self-rated health.ResultsOur analyses were based on 6 919 men and women who had no record of coeliac disease or hip fracture before the study baseline. 382 individuals had a hip fracture during a median follow-up of 30 years. Compared to the tTGA negative individuals (n=6 350), tTGA positive participants (n: 569, n with hip fracture: 51) had a higher risk of hip fractures (hazard ratio, HR: 1.59, 95% confidence interval, CI: 1.17, 2.14). The findings were similar for another tTGA test (n: 200, n with hip fracture: 26, HR: 2.23, 95% CI: 1.49, 3.34). We found no evidence for an association between EMA positivity and hip fracture risk (HR: 0.92, 95% CI: 0.34, 2.47; n: 74, n with hip fracture: 4).Conclusions In our prospective population-based study of Finnish adults seropositivity for tTGA, was associated with an increased hip fracture risk. © 2014 American Society for Bone and Mineral Research
    Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 10/2014; DOI:10.1002/jbmr.2380 · 6.04 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A multidisciplinary panel of 18 physicians and 3 non-physicians from eight countries (Sweden, UK, Argentina, Australia, Italy, Finland, Norway and the USA) reviewed the literature on diagnosis and management of adult coeliac disease (CD). This paper presents the recommendations of the British Society of Gastroenterology. Areas of controversies were explored through phone meetings and web surveys. Nine working groups examined the following areas of CD diagnosis and management: classification of CD; genetics and immunology; diagnostics; serology and endoscopy; follow-up; gluten-free diet; refractory CD and malignancies; quality of life; novel treatments; patient support; and screening for CD.
    Gut 06/2014; 63(8). DOI:10.1136/gutjnl-2013-306578 · 13.32 Impact Factor

Full-text (3 Sources)

Available from
Jun 1, 2014