In the Journals

Gluten-free diet fails to improve microscopic colitis symptoms in patients without celiac disease

Dietary gluten intake does not appear to be linked to a risk for microscopic colitis in women, according to research published in The American Journal of Gastroenterology.

Po-Hong Liu, MD, MPH, of the clinical and translational epidemiology unit at Massachusetts General Hospital, and colleagues wrote that although microscopic colitis is higher in patients with celiac disease, little research has been done to explore any link between gluten intake and microscopic colitis in patients without celiac disease.

“Previous reports have suggested that some patients with concomitant celiac disease may have improvements in disease activity following a gluten-free diet, minimizing the need for medical therapy,” they wrote. “Nevertheless, the role of gluten, the dietary antigen in celiac disease, in the pathogenesis of microscopic colitis remains largely unknown.”

Liu and colleagues analyzed data from 160,744 women without celiac disease enrolled in the Nurses’ Health Study and Nurses’ Health Study II. They estimated gluten intake using food frequency questionnaires taken every 4 years and confirmed microscopic colitis after reviewing medical records.

Investigators identified 219 cases of microscopic colitis during more than 20 years of follow-up (3,716,718 person-years). Gluten intake was not associated with risk for microscopic colitis (P = .88).

After grouping individuals based on energy-adjusted gluten intake, researchers found that compared with women in the lowest quintile, the adjusted HR of the middle quintile of microscopic colitis was 1.18 (95% CI, 0.77-1.78), and 1.03 in the highest quintile (95% CI, 0.67-1.58).

According to Liu and colleagues, although patients with celiac disease and microscopic colitis may experience a benefit from a gluten-free diet, gluten does not appear to have a role in the development of microscopic colitis in patients without celiac disease.

“These results are particularly relevant at a time when a low gluten diet or gluten-free diet are gaining popularity in the general population, especially in patients with chronic intestinal symptoms,” they wrote. “Our data suggest that the pathogenesis of microscopic colitis, at least in patients without celiac disease, is likely not related to gluten consumption and, therefore, in contrast to celiac disease, it is unlikely that gluten withdrawal would lead to improvement in histologic inflammation or clinical symptoms.” – by Alex Young

Disclosures: Liu reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Dietary gluten intake does not appear to be linked to a risk for microscopic colitis in women, according to research published in The American Journal of Gastroenterology.

Po-Hong Liu, MD, MPH, of the clinical and translational epidemiology unit at Massachusetts General Hospital, and colleagues wrote that although microscopic colitis is higher in patients with celiac disease, little research has been done to explore any link between gluten intake and microscopic colitis in patients without celiac disease.

“Previous reports have suggested that some patients with concomitant celiac disease may have improvements in disease activity following a gluten-free diet, minimizing the need for medical therapy,” they wrote. “Nevertheless, the role of gluten, the dietary antigen in celiac disease, in the pathogenesis of microscopic colitis remains largely unknown.”

Liu and colleagues analyzed data from 160,744 women without celiac disease enrolled in the Nurses’ Health Study and Nurses’ Health Study II. They estimated gluten intake using food frequency questionnaires taken every 4 years and confirmed microscopic colitis after reviewing medical records.

Investigators identified 219 cases of microscopic colitis during more than 20 years of follow-up (3,716,718 person-years). Gluten intake was not associated with risk for microscopic colitis (P = .88).

After grouping individuals based on energy-adjusted gluten intake, researchers found that compared with women in the lowest quintile, the adjusted HR of the middle quintile of microscopic colitis was 1.18 (95% CI, 0.77-1.78), and 1.03 in the highest quintile (95% CI, 0.67-1.58).

According to Liu and colleagues, although patients with celiac disease and microscopic colitis may experience a benefit from a gluten-free diet, gluten does not appear to have a role in the development of microscopic colitis in patients without celiac disease.

“These results are particularly relevant at a time when a low gluten diet or gluten-free diet are gaining popularity in the general population, especially in patients with chronic intestinal symptoms,” they wrote. “Our data suggest that the pathogenesis of microscopic colitis, at least in patients without celiac disease, is likely not related to gluten consumption and, therefore, in contrast to celiac disease, it is unlikely that gluten withdrawal would lead to improvement in histologic inflammation or clinical symptoms.” – by Alex Young

Disclosures: Liu reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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