Publisher: Research Institute for Gastroenterology and Liver Diseases (RIGLD)
  • Register
  • Login

Gastroenterology and Hepatology from Bed to Bench

  • Home
  • Issues
    • Current
    • Archives
  • About
    • About the Journal
    • Aims and Scope
    • Editorial Team
    • Privacy Statement
    • Contact
  • For Authors
    • Submissions
    • Author Guidelines
    • Peer Review Process
  • Indexing & Abstracting
  • Announcements
Advanced Search
  1. Home
  2. Archives
  3. Vol 14, No 4 (2021): Autumn
  4. Original Article

ISSN: 2008-2258

Vol 14, No 4 (2021): Autumn

Adult celiac disease with persistent IBS-type symptoms: a pilot study of an adjuvant FODMAP diet

  • Nick Trott
  • Dr Anupam Rej
  • Sarah Coleman
  • Professor David Sanders

Gastroenterology and Hepatology from Bed to Bench, ,
https://doi.org/10.22037/ghfbb.v14i4.2282 Published 23 August 2021

  • View Article
  • Download
  • Cite
  • References
  • Statastics
  • Share

Abstract

Background and Aims


Patients with biopsy proven adult celiac disease (CD) may have on-going gastrointestinal symptoms despite adherence to the gluten-free diet (GFD). Functional gut symptoms including Irritable Bowel Syndrome (IBS) is one cause of persisting symptoms in CD patients. This pilot study assessed the benefit of an adjuvant low FODMAP diet (LFD) in adult CD patients established on GFD who had a normal remission biopsy.


Methods


Twenty-five adult CD patients who were adherent to the GFD were recruited. These patients had histologically normal villi on their remission biopsy. A specialist dietitian then offered an adjuvant LFD. Symptom response was assessed using the Gastrointestinal Symptom Rating Scale (GSRS) from baseline to follow up.


Results


Of the 25 CD patients in remission with concurrent IBS 9 patients did not wish to pursue the LFD, 1 patient had incomplete data. Fifteen patients completed a minimum of four weeks on the LFD (mean age 44 ± 17.3; median duration of follow-up 7.2 years; range 43.2 years). Global symptom relief of gut symptoms was reported by 8/15 patients (53% P = 0.007). Significant reductions in abdominal pain (P <0.01) distension (P < 0.02) and flatulence (P <0.01) were demonstrated.


Conclusions


This is the first study to demonstrate an adjunct LFD is an effective dietary treatment for concurrent IBS in adult CD patients with biopsy-confirmed remission. Such patients should be seen by a specialist dietitian to ensure nutritional adequacy and appropriate reintroduction of FODMAP containing foods.

Keywords:
  • Celiac Disease; Irritable Bowel Syndrome; Diet, Gluten-Free.
  • PDF

How to Cite

Trott, N., Rej, D. A., Coleman, S., & Sanders, P. D. (2021). Adult celiac disease with persistent IBS-type symptoms: a pilot study of an adjuvant FODMAP diet . Gastroenterology and Hepatology from Bed to Bench, 14(4). https://doi.org/10.22037/ghfbb.v14i4.2282
  • ACM
  • ACS
  • APA
  • ABNT
  • Chicago
  • Harvard
  • IEEE
  • MLA
  • Turabian
  • Vancouver
  • Endnote/Zotero/Mendeley (RIS)
  • BibTeX

References

1. Singh P, Arora A, Strand TA, et al. Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2018;16:823-836.e2.
2. O’Mahony S, Howdle PD, Losowsky MS. Review article: Management of patients with non-responsive coeliac disease. Aliment Pharmacol Ther 1996;10:671-680. http://doi.wiley.com/10.1046/j.1365-2036.1996.66237000.x.
3. Mooney PD, Evans KE, Singh S, et al. Treatment failure in coeliac disease: a practical guide to investigation and treatment of non-responsive and refractory coeliac disease. J Gastrointestin Liver Dis 2012;21:197-203.
4. Penny HA, Baggus EMR, Rej A, et al. Non-Responsive Coeliac Disease: A Comprehensive Review from the NHS England National Centre for Refractory Coeliac Disease. Nutrients 2020;12:216.
5. Sainsbury A, Sanders DS, Ford AC. Prevalence of Irritable Bowel Syndrome–type Symptoms in Patients With Celiac Disease: A Meta-analysis. Clin Gastroenterol Hepatol 2013;11:359-365.e1.
6. Mulak A, Waszczuk E, Paradowski L. Anorectal Function and Visceral Hypersensitivity in Celiac Disease. J Clin Gastroenterol 2010;44:e249-e252.
7. Lebwohl B, Hassid B, Ludwin S, et al. Increased sedation requirements during endoscopy in patients with celiac disease. Dig Dis Sci 2012;57:994-999.
8. Fasano A. Celiac disease, gut-brain axis, and behavior: Cause, consequence, or merely epiphenomenon? Pediatrics 2017;139.
9. Ball AJ, Hadjivassiliou M, Sanders DS. Is Gluten Sensitivity a “No Man’s Land” or a “Fertile Crescent” for Research? Am J Gastroenterol 2010;105:222-223.
10. See JA, Kaukinen K, Makharia GK, et al. Practical insights into gluten-free diets. Nat Rev Gastroenterol Hepatol 2015;12:580-591.
11. Altobelli E, Del Negro V, Angeletti PM, et al. Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis. Nutrients 2017;9:940.
12. Bascuñán KA, Elli L, Pellegrini N, et al. Impact of FODMAP Content Restrictions on the Quality of Diet for Patients with Celiac Disease on a Gluten-Free Diet. Nutrients 2019;11:2220.
13. Testa A, Imperatore N, Rispo A, et al. The Efficacy of the Low Fodmap Diet for Improving Symptoms in Inflammatory Bowel Diseases and Celiac Disease. Dig Dis May 2018:1-10.
14. Roncoroni L, Bascuñán K, Doneda L, et al. A Low FODMAP Gluten-Free Diet Improves Functional Gastrointestinal Disorders and Overall Mental Health of Celiac Disease Patients: A Randomized Controlled Trial. Nutrients 2018;10:1023.
15. Mulder CJ, Wierdsma NJ, Berkenpas M, et al. Preventing complications in celiac disease: Our experience with managing adult celiac disease. Best Pract Res Clin Gastroenterol 2015;29:459-468.
16. Silvester JA, Kurada S, Szwajcer A, et al. Tests for Serum Transglutaminase and Endomysial Antibodies Do Not Detect Most Patients With Celiac Disease and Persistent Villous Atrophy on Gluten-free Diets: a Meta-analysis. Gastroenterology 2017;153:689-701.e1.
17. Sharkey LM, Corbett G, Currie E, et al. Optimising delivery of care in coeliac disease - comparison of the benefits of repeat biopsy and serological follow-up. Aliment Pharmacol Ther 2013;38:1278-1291.
18. Longstreth GF, Thompson WG, Chey WD, et al. Functional Bowel Disorders. Gastroenterology 2006;130:1480-1491.
19. Svedlund J, Sjödin I, Dotevall G. GSRS--a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Dig Dis Sci 1988;33:129-134.
20. Lacy BE, Mearin F, Chang L, et al. Bowel disorders. Gastroenterology 2016;150:1393-1407.e5.
21. Irvine EJ, Whitehead WE, Chey WD, et al. Design of Treatment Trials for Functional Gastrointestinal Disorders. Gastroenterology 2006;130:1538-1551.
22. Leffler DA, Dennis M, Hyett B, et al. Etiologies and Predictors of Diagnosis in Nonresponsive Celiac Disease. Clin Gastroenterol Hepatol 2007;5:445-450.
23. Baggus EMR, Hadjivassiliou M, Cross S, et al. How to manage adult coeliac disease: Perspective from the NHS England Rare Diseases Collaborative Network for Non-Responsive and Refractory Coeliac Disease. Frontline Gastroenterol 2019:1-8.
24. NICE. Coeliac disease: recognition, assessment and management [NG20]. National Institute of Health Care and Excellence. Natl Inst Heal Care Excell 2016.
25. Rubio-Tapia A, Hill ID, Kelly CP, et al. ACG clinical guidelines: Diagnosis and management of celiac disease. Am J Gastroenterol 2013;108:656-676.
26. Ludvigsson JF, Bai JC, Biagi F, et al. Diagnosis and management of adult coeliac disease: Guidelines from the British society of gastroenterology. Gut 2014;63:1210-1228.
27. Gładyś K, Dardzińska J, Guzek M, et al. Celiac dietary adherence test and standardized dietician evaluation in assessment of adherence to a gluten-free diet in patients with celiac disease. Nutrients 2020;12:1-10.
28. White LE, Bannerman E, Gillett PM. Coeliac disease and the gluten-free diet: a review of the burdens; factors associated with adherence and impact on health-related quality of life, with specific focus on adolescence. J Hum Nutr Diet 2016;29:593-606.
29. Cheng FW, Handu D. Nutrition Assessment, Interventions, and Monitoring for Patients with Celiac Disease: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2020;120:1381-1406.
30. Rej A, Buckle RL, Shaw CC, et al. National survey evaluating the provision of gastroenterology dietetic services in England. Frontline Gastroenterol 2020:flgastro-2020-101493.
31. Eswaran SL, Chey WD, Han-Markey T, et al. A Randomized Controlled Trial Comparing the Low FODMAP Diet vs. Modified NICE Guidelines in US Adults with IBS-D. Am J Gastroenterol 2016;111:1824-1832.
32. Whigham L, Joyce T, Harper G, et al. Clinical effectiveness and economic costs of group versus one-to-one education for short-chain fermentable carbohydrate restriction (low FODMAP diet) in the management of irritable bowel syndrome. J Hum Nutr Diet 2015;28:687-696.
  • Abstract Viewed: 0 times
  • PDF Downloaded: 0 times

Download Statastics

  • Linkedin
  • Twitter
  • Facebook
  • Google Plus
  • Telegram
Open Journal Systems
Keywords
Current Issue
  • Atom logo
  • RSS2 logo
  • RSS1 logo
  • Home
  • Archives
  • Submissions
  • About the Journal
  • Editorial Team
  • Contact

GHFBB journal is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).

Print ISSN: 2008-2258
Online ISSN: 2008-4234

Support Contact: ghfbb.journal@gmail.com

 

GHFBB is an open-access journal and does not charge fees for authors who submit their articles and for readers who access PDF files of published articles.

The template of this website is designed by Sinaweb