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Gluten-free diet benefited asymptomatic patients with positive celiac disease biomarkers
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Asymptomatic individuals who tested positive for serologic markers of celiac disease benefited from a gluten-free diet, supporting active screening for the disease in at-risk groups, according to clinical trial results.
Researchers from Finland conducted a prospective trial of 3,031 at-risk relatives of patients with celiac disease to assess whether asymptomatic adults with endomysial antibodies (EmA) would benefit from serologic screening and gluten-free diet (GFD). Screening detected EmA positivity in 148 patients, 40 of whom were randomly assigned to a GFD group or a control group on a gluten-containing diet. Small-bowel mucosal biopsy specimens were taken, and serologic and laboratory parameters, clinical symptoms, QOL scores, BMD, BMI and body composition were analyzed at baseline, 1 year and 2 years.
After 1 year, GFD patients had increased mucosal villous height/crypt depth values (P<.001), and decreased levels of celiac-associated antibodies (EmA and transglutaminase 2 antibodies; both P=.003). Overall gastrointestinal symptoms were improved in GFD compared with controls (absolute difference, –0.4; 95% CI, –0.7 to –0.1), with the most significant improvements in indigestion (–0.7; 95% CI, –1.1 to –0.2) and reflux (–0.5; 95% CI, –0.9 to –0.1).
The GFD group also had improved anxiety (1.6; 95% CI, 0.4-2.8) and better perception of health by visual analog scale (P=.017) compared with controls. Social function scores alone improved more in the control group vs. the GFD group (–8.3; 95% CI, –15.8 to –0.8). When controls were placed on GFD after 1 year, most measured variables improved. Overall no participants reported a negative experience, 92% reported adherence to GFD and 85% planned to remain on GFD.
“Our randomized study showed that apparently asymptomatic EmA-positive subjects benefit from serologic screening and a subsequent GFD,” the researchers concluded. “The results support active screening of celiac disease in at-risk groups.”
“This study provides some of the strongest data yet supporting celiac disease screening of family members of patients with celiac disease,” Daniel A. Leffler, MD, and , MD, of Harvard Medical School and the Celiac Center at Beth Israel Deaconess Medical Center, wrote in an accompanying editorial. “However, important issues must be addressed before screening is widely adopted.”
Ciarán P. Kelly
They cited the small cohort, Finland’s uniquely accommodating treatment infrastructure, and the social and economic burdens of GFD. Leffler and Kelly also said larger randomized trials of celiac disease screening were needed, and that the study “provides much needed data to inform patients and their physicians on the modest benefits as well as the costs of testing for celiac disease in minimally symptomatic family members.”
Disclosure: The researchers report no relevant financial disclosures.
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