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Review
. 2023 Sep 6;23(1):301.
doi: 10.1186/s12876-023-02934-w.

Prevalence of vomiting and nausea and associated factors after chronic and acute gluten exposure in celiac disease

Iida Ahonen  1 , Pilvi Laurikka  1   2 , Sara Koskimaa  1   3 , Heini Huhtala  4 , Katri Lindfors  1 , Katri Kaukinen  1   2 , Kalle Kurppa  1   3   5 , Laura Kivelä  6   7   8
Affiliations
Review

Prevalence of vomiting and nausea and associated factors after chronic and acute gluten exposure in celiac disease

Iida Ahonen et al. BMC Gastroenterol. .

Abstract

Background: Vomiting and nausea seem to be relatively specific symptoms related to gluten ingestion in treated celiac disease. However, the overall prevalence and associated factors of these symptoms after chronic gluten exposure at celiac disease diagnosis and acute re-exposure during gluten challenge remain obscure.

Methods: Medical data on 815 adult celiac disease patients were collected at diagnosis from the medical records and through supplementary interviews. An additional 74 patients underwent a three-day (10 g/day) gluten challenge (wheat, barley, rye or a combination of the three grains) while in remission. Prevalence of vomiting/nausea and associated factors were evaluated in both cohorts. A literature review was conducted to summarize earlier studies.

Results: Twenty-eight (3%) patients presented with vomiting at diagnosis. They were less often screen-detected and suffered from extra-intestinal symptoms, and had more often abdominal pain (71% vs. 49%, p = 0.021), diarrhea (61% vs. 40%, p = 0.031), weight loss (36% vs. 17%, p = 0.019) and childhood symptoms (61% vs. 33%, p = 0.002) than those without vomiting (n = 787). The groups were comparable in other clinical-demographic data and in genetic, serological, and histological findings. Short-term gluten challenge provoked vomiting/nausea in 14/74 (19%) patients. They consumed gluten-free oats less often than those without these symptoms (64% vs. 92%, p = 0.017), whereas the groups did not differ in clinical-demographic features at diagnosis, presence of comorbidities, duration of gluten-free diet, or in other symptoms or grain used ingested during the challenge. According to the literature, prevalence of vomiting/nausea at celiac disease diagnosis has varied 3-46% and during gluten challenge 13-61%.

Conclusions: In chronic gluten exposure at celiac disease diagnosis, vomiting was associated with other gastrointestinal symptoms and onset of symptoms already in childhood, whereas regular consumption of oats may increase the tolerance against vomiting/nausea after acute re-exposure in treated celiac disease.

Keywords: Celiac disease; Gluten challenge; Nausea; Vomiting.

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Conflict of interest statement

Laura Kivelä, Pilvi Laurikka, and Kalle Kurppa have received personal lecture fees from the Finnish Coeliac Society outside the submitted work and Laura Kivelä, Pilvi Laurikka, Katri Kaukinen, Katri Lindfors and Kalle Kurppa serve as members of the advisory committee of the Finnish Coeliac Society. Kalle Kurppa is a board member of the International Society for the Study of Celiac Disease and Katri Lindfors of the Multisociety Celiac Disease Consortium. Kalle Kurppa and Pilvi Laurikka have received personal lecture fees from Thermo Fisher Scientific outside the work submitted here. The other authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
Prevalence of vomiting and other symptoms in untreated celiac disease at the time of diagnosis (n = 815). Data about nausea was not available. Asymptomatic patients were found by screening at-risk groups
See this image and copyright information in PMC

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