Microbiome status unrelated to current celiac disease activity, severity
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Pre-existing fecal microbiome diversity was unaffected by gluten challenge in patients with celiac disease and nonceliac gluten sensitivity, according to data published in Clinical and Translational Gastroenterology.
“Investigations of celiac disease (CD) have posited a role of the gut microbiome in multiple aspects of disease development and progression,” Yael R. Nobel, MD, a gastroenterology and hepatology fellow at Columbia University Irving Medical Center in New York City, and colleagues wrote. “Certain taxa, including Bifidobacterium and Clostridial species such as Faecalibacterium prausnitzii, have decreased abundance in patients with active CD or treated CD compared with controls.”
They added: “However, not all studies have shown consistent trends, and some of the dysbiosis observed in patients with CD may be attributable to gluten-free diet rather than to the underlying disease.”
In a prospective study, Nobel and colleagues investigated the impact of gluten exposure on gut microbiome composition in a clinic-based cohort of nine patients with CD and eight with nonceliac gluten sensitivity (NCGS), all of whom were previously on a long-term, gluten-free diet. The cohort was compared with a control group on a standard gluten-containing diet.
Participants in the CD and NCGS groups received a 14-day gluten challenge, consisting of 5 grams of gluten per day, while the control group maintained nonrestrictive diets. Researchers assessed clinical symptoms and collected stool samples at five timepoints before, during and after the gluten challenge for fecal microbiome analysis using 16S rRNA gene and metagenomic sequencing.
Researchers found no significant fecal microbial changes in response to gluten challenge among participants with CD and NCGS. However, gut microbiome composition differed at baseline between controls, those with CD and those with NCGS, and these differences continued despite gluten exposure. The CD and NCGS groups reported more severe symptoms than controls at all timepoints, with GI and general health symptoms being worst in the middle of gluten challenge and lessening by its end. There were no consistent associations with these symptoms and gut microbiome composition.
“Our findings indicate that in people with CD and NCGS on a long-term, gluten-free diet, short-term gluten consumption does not alter gut microbiome composition,” Nobel and colleagues concluded. “Gut microbial dysbiosis in patients with established CD or NCGS is unlikely to meaningfully impact disease activity and symptom severity in patients with these conditions.”
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