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PTH-083 is there a relationship between gluten free diet adherence and symptomatic responses to gluten in coeliac disease?
  1. S M Barratt,
  2. J S Leeds,
  3. D S Sanders
  1. The GI and Liver Unit, The Royal Hallamshire Hospital, Sheffield, UK


Introduction The gluten-free diet (GFD) is the mainstay of treatment in Coeliac Disease (CD). Many individuals report difficulty adhering to the diet facing social obstacles in which inadvertent exposure to gluten occurs. There are limited data surrounding the character, timing and severity of symptomatic responses to dietary gluten. We wished to assess if there was a relationship between adherence and the development of symptoms when exposed to gluten.

Methods Postal survey (n=224) of CD patients with histologically proven disease. Questionnaire included an assessment of GFD adherence level normally achieved with psychological wellbeing assessed by The Hospital Anxiety and Depression Scale (HADS). Method of presentation (MOP) and disease duration were ascertained by medical records. Patients were categorised into typical- gastrointestinal (GI) symptoms (n=138), atypical- no GI symptoms (n=41) and screening (n=36).

Results Individuals reporting GFD adherence “All the time” (n=159) were less likely to experience bloating (OR 0.54) and fatigue (OR 0.5) compared to individuals with “Partial/None” adherence in response to dietary gluten (p=<0.05). Crucially, the consistently adherent group were more likely to experience symptoms quicker (<1 h) and to a greater severity than partial/none adherent respondents since starting the GFD (OR 1.8 and OR 2.3, respectively, p=0.01). Individuals with screening MOP reported less abdominal pain, diarrhoea and bloating in response to gluten compared to typical and atypical. However, atypical MOP was associated with an increase in headaches (p=<0.05). In response to gluten individuals with HADS scores suggesting anxiety and depression were more likely to experience abdominal pain, headaches, insomnia, mouth ulcers, fatigue and nausea compared to those with low HADS scores (p=<0.05). Anxiety alone was associated with more abdominal pain and insomnia in response to gluten (p=<0.05). Disease duration had no impact on symptomatic responses.

Conclusion We are the first group to describe that there is a relationship between GFD adherence and the development of symptoms on exposure to gluten. This may be because of the initial MOP (which ensures subsequent GI symptoms if exposed to gluten) or because adherent patients are more likely to have “immune tolerance” and thus develop more severe symptoms when exposed to gluten. It is also interesting to note that the presence of anxiety and depression means more symptoms (when exposed to gluten) or are these individuals just more sensitive to their symptoms? Further prospective longitudinal data are required to support our preliminary observations. Our data may suggest that certain groups of patients could be identified where follow-up is essential in order to ensure optimal adherence.

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