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. 2021 May 26;13(6):1812.
doi: 10.3390/nu13061812.

Long-Term Effect of a Gluten-Free Diet on Diarrhoea- or Bloating-Predominant Functional Bowel Disease: Role of the 'Low-Grade Coeliac Score' and the 'Coeliac Lymphogram' in the Response Rate to the Diet

Fernando Fernández-Bañares  1   2 , Beatriz Arau  1   2 , Agnès Raga  1 , Montserrat Aceituno  1   2 , Eva Tristán  1   2 , Anna Carrasco  1   2 , Laura Ruiz  1   2 , Albert Martín-Cardona  1   2 , Pablo Ruiz-Ramírez  1 , Maria Esteve  1   2
Affiliations

Long-Term Effect of a Gluten-Free Diet on Diarrhoea- or Bloating-Predominant Functional Bowel Disease: Role of the 'Low-Grade Coeliac Score' and the 'Coeliac Lymphogram' in the Response Rate to the Diet

Fernando Fernández-Bañares et al. Nutrients. .

Abstract

1.

Background: The long-term effect of a gluten-free diet (GFD) on functional bowel disorders (FBDs) has been scarcely studied. The aim was to assess the effect of a GFD on FBD patients, and to assess the role of both the low-grade coeliac score and coeliac lymphogram in the probability of response to a GFD. 2.

Methods: 116 adult patients with either predominant diarrhoea or abdominal bloating, fulfilling Rome IV criteria of FBD, were treated with a GFD. Duodenum biopsies were performed for both pathology studies and intraepithelial lymphocyte subpopulation patterns. Coeliac lymphogram was defined as an increase in TCRγδ+ cells plus a decrease in CD3- cells. A low-grade coeliac score >10 was considered positive. 3.

Results: Sustained response to GFD was observed in 72 patients (62%) after a median of 21 months of follow-up, who presented more often with coeliac lymphogram (37.5 vs. 11.4%; p = 0.02) and a score >10 (32 vs. 11.4%; p = 0.027) compared to non-responders. The frequency of low-grade coeliac enteropathy was 19.8%. 4.

Conclusion: A GFD is effective in the long-term treatment of patients with previously unexplained chronic watery diarrhoea- or bloating-predominant symptoms fulfilling the criteria of FBD. The response rate was much higher in the subgroup of patients defined by the presence of both a positive low-grade coeliac score and coeliac lymphogram.

Keywords: FODMAP diet; coeliac disease; functional bowel disease; gluten-free diet; non-coeliac gluten sensitivity; tissue biomarkers.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Response rate to a GFD in function of the presence of the different coeliac parameters and the low-grade coeliac score (* p < 0.012 vs. score ≤ 10). The different parameters are interrelated, the score integrates individual parameters, and it is not possible to separate the scoring system from the coeliac lymphogram: most patients with a positive score (>10) had a coeliac lymphogram and vice versa.
See this image and copyright information in PMC

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