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Adherence to the gluten‐free diet can achieve the therapeutic goals in almost all patients with coeliac disease: A 5‐year longitudinal study from diagnosis
Author(s) -
Newnham Evan D,
Shepherd Susan J,
Strauss Boyd J,
Hosking Patrick,
Gibson Peter R
Publication year - 2016
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13060
Subject(s) - medicine , coeliac disease , body mass index , osteopenia , lean body mass , gluten free , gastroenterology , osteoporosis , gluten , disease , bone mineral , pathology , body weight
Background Key aims of treatment of coeliac disease are to heal the intestinal mucosa and correct nutritional abnormalities. Aim We aim to determine prospectively the degree of success and time course of achieving those goals with a gluten‐free diet. Methods Ninety‐nine patients were enrolled at diagnosis and taught the diet. The first 52 were reassessed at 1 year and 46 at 5 years, 25 being assessed at the three time points regarding dietary compliance (dietitian‐assessed), coeliac serology, bone mineral density and body composition analysis by dual energy X‐ray absorptiometry, and intestinal histology. Results Mean age (range) was 40 (18–71) years and 48 (76%) were female. Dietary compliance was very good to excellent in all but one. Tissue transglutaminase IgA was persistently elevated in 44% at 1 year and 30% at 5 years and were poorly predictive of mucosal disease. Rates of mucosal remission (Marsh 0) and response (Marsh 0/1) were 37% and 54%, and 50% and 85% at 1 and 5 years, respectively. Fat mass increased significantly over the first year in those with normal/reduced body mass index. Lean body mass indices more slowly improved irrespective of status at diagnosis with significant improvement at 5 years. Bone mass increased only in those with osteopenia or osteoporosis, mostly in year 1. Conclusion Dietary compliance is associated with a high chance of healing the intestinal lesion and correction of specific body compositional abnormalities. The time course differed with body fat improving within 1 year, and correction of the mucosal lesion and improvement in lean mass and bone mass taking longer.