Patients with celiac disease have trouble determining gluten exposure based on symptoms
PHILADELPHIA — Patients with celiac disease who rely on symptoms to know when they have been exposed to gluten have trouble determining if they have truly ingested gluten, according to research presented at the American College of Gastroenterology Annual Meeting.
“Many patients on a gluten-free diet describe non-specific and functional gastrointestinal symptoms which may be related to gluten exposure,” Amanda K. Cartee, MD, of the Mayo Clinic in Rochester, Minnesota, said in her presentation. “Currently, there is no FDA-approved test to confirm gluten exposure. Thus, patients with celiac disease rely on symptoms as an indicator of gluten exposure.”
Cartee and colleagues developed a double-blind, placebo-controlled gluten challenge to characterize the rapid onset of symptoms after gluten exposure and to find out if the patients with celiac disease were able to determine if they had been exposed to gluten. They recruited 14 patients with celiac disease and 14 healthy controls for the trial.
Researchers randomly assigned each patient to receive either a 6 g gluten suspension or placebo. Each patient completed a 100 mm visual analog questionnaire to assess their symptoms at baseline, every 30 minutes to 60 minutes for 6 hours and then daily for 3 days. They also asked patients at each time point if they believed they received gluten.
During the study, only two of the seven patients with celiac disease who received gluten were able to correctly identify the gluten suspension. Cartee said it took a full day for one patient to come to that conclusion, while another gave varied responses sporadically throughout the study.
The most common symptoms for patients with celiac disease were nausea and abdominal pain. There was no statistical difference in symptoms in the gluten celiac disease group compared with the placebo celiac disease group.
Cartee said because symptoms are subjective and non-specific, they were mostly an unreliable way to self-diagnose gluten exposure.
“We really need an objective means to identify gluten-related symptoms, particularly in our patients with celiac disease with ongoing gastrointestinal symptoms,” she said. – by Alex Young
Cartee AK, et al. Abstract 47. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 5-10, 2018; Philadelphia.
Disclosure: The authors report no relevant financial disclosures.