Digestive Disease Week (DDW) 2019

May 18-21, San Diego. Research summaries

 

GIG’s Education Supervisor, Lola O’Rourke MS, RDN, recently attended the 50th anniversary Digestive Disease Week (DDW) conference in San Diego and has compiled an impressive list of summaries of the latest research on celiac disease, non-celiac gluten sensitivity, and gluten-related disorders.  Be sure to check these out to stay up to date on the newest research in the field!

 

 

CELIAC DISEASE

 

“UTILITY OF SYMPTOM SEVERITY, FREQUENCY, AND LABILITY IN PREDICTING SEROLOGY STATUS AND VILLOUS INJURY IN SYMPTOMATIC ADULTS WITH TREATED CELIAC DISEASE”

Authors: Adam Bledsoe, Jack Syage, Katherine King, Tsung-Teh Wu, Joseph Murray

Symptoms alone are not enough for indicating whether intestinal healing has occurred in celiac disease patients who are on a gluten-free diet.

This study aimed to assess whether symptom frequency and lability (changeability) in celiac disease patients could predict intestinal damage and CD antibody levels.  As background, it was noted that after one year approximately 55% of CD patients show villous improvement, and after 5 years, approximately 85% do, leaving a significant portion not showing the desired improvement. The study looked at data on symptoms, biopsies and CD antibody results of 1276 CD patients. The average age was 47, and about 20% were male. Factors evaluated included proportion of days with tiredness, proportion of days with bloating, and overall mean symptom score (assessed using a standard Celiac Disease Symptom Diary).Results showed that symptoms were inconsistent in terms of predicting objective measures of celiac disease control (improvement in intestinal damage or CD antibody levels). The authors note that their findings reinforce the importance of clinicians not relying just on symptoms when assessing patients’ response to a gluten-free diet. Since diarrhea was the only symptom that did show an association with intestinal cell damage,  this symptom is one which should prompt clinicians to consider re-evaluating status of intestinal recovery. Other symptom severity, frequency and lability did not predict intestinal damage.

 

“REAL LIFE PATTERNS OF GLUTEN-FREE DIET ADHERENCE IN CELIAC PATIENTS USING GIP EXCRETION”

presented by Juan Stefanolo

Authors: Juan Pablo Stefanolo, Martín Tálamo, Samanta Dodds, Emilia Sugai, Paz Temprano, Ana Costa, María Laura Moreno, María Inés Pinto Sanchez, Edgardo Smecuol, Horacio Vázquez, Andrea Fabiana Gonzalez, Sonia Isabel Niveloni, Elena Francisca Verdu, Eduardo Mauriño, Julio C. Bai

Testing finds that celiac disease patients are frequently exposed to gluten contamination, and whether or not they had symptoms had no correlation with the level of contamination experienced.

Background: patients with CD who are on a gluten-free diet are often exposed to gluten contamination, and it is unknown how frequently this occurs in real life settings. This research explored the pattern of urinary and fecal excretion of gluten immunogenic peptide (GIP) during a 4 week period in CD patients who had been on a gluten-free diet for more than two years. At the beginning of the study patients completed a celiac symptom index (CSI) questionnaire to determine presence of symptoms. Patients collected samples that would reflect both weekday and weekend food intake. Results showed that 96% of cases had transgressions at least once during the 4 week period.   91% had transgressions during weekends, and 48% during week-days. There was no difference between symptomatic and asymptomatic individuals, and there was no correlation between transgressions and symptoms. The authors concluded that there is a high frequency of dietary transgressions in CD patients who are on a long-term GFD, whether or not they have symptoms, and that ingestion of gluten was more common on weekends.

 

“A THEORY-BASED, BEHAVIORALLY FOCUSED COOKING INTERVENTION FOR ADULTS WITH CELIAC DISEASE INCREASED GLUTEN-FREE DIET ADHERENCE AND QUALITY OF LIFE”

Authors: Randi L. Wolf, Mary Morawetz, Anne R. Lee, Pamela A. Koch, Isobel R. Contento, Peter H. R. Green, Benjamin Lebwohl

Participation in cooking class improves quality of life for celiac disease patients.

As background, it is noted that few studies have addressed mechanisms for encouraging adherence to a GFD for those with CD. The aim of this pilot study was to determine whether an innovative cooking intervention could improve adherence to the gluten-free diet (GFD) and quality of life in individuals with CD. 12 adults (aged 18-70) were enrolled, and participated in two 4.5 hour sessions. Goals were to increase home-cooked meals with naturally GF proteins and whole grains, and increase nutrient dense snacks from whole grains, nuts, and seeds.  Each of the following were measured at the beginning of the study, and again after completion:    CD-specific quality of life; symptoms, diet adherence, depression, and anxiety. After the one month period, participants had significant positive outcomes: greater dietary adherence, improved quality of life, and lower depression and anxiety scores. The authors conclude that this approach warrants further investigation in a larger controlled study.

 

“EFFECT OF BIFIDOBACTERIUM INFANTIS NSL SUPER STRAIN IN HIGHLY SYMPTOMATIC CELIAC DISEASE PATIENTS ON LONG-TERM GLUTEN-FREE DIET. A PILOT STUDY”

AuthorsEdgardo Smecuol, Paz Temprano, Ana Costa, Emilia Sugai, María Laura Moreno, María Inés Pinto Sanchez, Horacio Vázquez, Juan Pablo Stefanolo, Andrea Fabiana Gonzalez, Christopher R. D’Adamo, Sonia Isabel Niveloni, Elena Francisca Verdu, Eduardo Mauriño, Julio C. Bai, Dr. C. Bonorino

Probiotic alleviates symptoms in some celiac disease patients.

As background it is noted that 30-50% of treated CD patients have persistent or relapsing GI symptoms despite apparent compliance with the GFD. Also, that a recent trial showed that oral administration of  the probiotic Bifidobacterium infantis NLS-SS alleviated symptoms in newly diagnosed CD patients consuming gluten and that this effect could be attributed to the modulation of innate immunity. The aim of this study was to explore the effects of a 3 week course of Bifidobacterium infantis NLS-SS on CD patients with persistent symptoms. 18 adult patients were enrolled who had been on a GFD for at least two years and were symptomatic according to a GI symptoms rating score. Patients were divided into two groups, with one receiving the B. Infantis, and the other receiving placebo. After a “wash out” period, patients then switched treatments.  Results led the authors to conclude that B infantis may improve specific CD symptoms on a GFD in patients who have a higher symptomatic burden.    Additional larger studies are called for to further investigate this effect.

“ASSOCIATION BETWEEN PRENATAL ANTIBIOTICS EXPOSURE AND THE RISK OF CELIAC DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS”

Authors: Muhammad Akrmah, Mohammed Ubaid Alsaggaf, Maryam R Hussain

No connection found between antibiotic exposure during pregnancy and development of celiac disease in offspring.

Background: Infections and use of antibiotics are common during pregnancy and may affect fetal development and autoimmunity. This research aimed to assess the evidence of a relationship between antibiotic exposure during pregnancy and celiac disease development in the offspring. A comprehensive review and meta-analysis was done of relevant studies published between 1948 and 2018. Only 3 studies qualified for inclusion in the final analysis.  This meta-analysis did not suggest any association between antibiotic exposure during pregnancy and increased risk of celiac disease in childhood.  The authors note, however, that additional future research is needed to study this potential association.

 

“SYMPTOM PROFILES, GLUTEN FREE DIET ADHERENCE, AND LABORATORY DATA DO NOT RELIABLY PREDICT DUODENAL MUCOSAL HEALING IN FOLLOW UP BIOPSIES FROM PATIENTS WITH CELIAC DISEASE IN A MULTINATIONAL PATHOLOGY BASED COHORT”

AuthorsNatalie J. Patel, Amporn Atsawarungruangkit, Daniel A. Leffler, John A. Hart, Andrea Olivas, Michael Vieth, Balint Melcher, Abdulbaqi Al-toma, Chris J.J. Mulder, Marcela A. Salomao, Rish Pai, Mary P. Bronner, Mariana Moreno Prats, Bita V. Naini, Cherise Meyerson, Luca Elli, Alessandro del Gobbo, Sanjay Kakar, Won-Tak Choi, Purva Gopal, Maria Westerhoff, Jerome Cheng, Marie Robert

No connection found between either symptoms or lab tests and persistence of intestinal damage in celiac disease individuals on a gluten-free diet.

Lack of complete intestinal healing in celiac disease is not uncommon, despite adherence to a gluten-free diet.  These researchers aimed to define factors associated with mucosal healing and persistent villous atrophy, in order to better classify and identify populations which may benefit from additional therapies, and to evaluate the role of repeat biopsy.  214 paired biopsies (initial and repeat) were obtained from 107 patients; mean time between initial and repeat biopsy was 2.4 years. Other factors assessed included symptoms, CD antibody levels, dietary adherence, and medications. Overall, no statistical difference was found between the incidence of specific symptoms and persistence of intestinal damage. The authors concluded that common laboratory tests, and signs and symptoms of celiac disease do not reliably predict duodenal mucosal healing at re-biopsy, that blunting of intestinal cells may be present in spite of clinical improvement, and that their findings support the need for assessment of mucosal healing in celiac disease.