Gluten-Free Diet Does Not Provide Benefit for All Children with Celiac Disease

A new study published in the Journal of Pediatric Gastroenterology and Nutrition, has found that almost 20 percent of children with celiac disease who are on a gluten-free diet, still show intestinal abnormalities a year after beginning treatment. According to the study authors, symptoms and results from lab tests are not predictive of which patients will experience persistent celiac enteropathy.

“These findings suggest that a revisitation of monitoring and management criteria of celiac disease in childhood,” said Dr. Maureen Leonard of Mass General Hospital for Children in Boston. The researchers completed their study by analyzing the medical records belonging to 103 children with celiac disease.

Patients with celiac disease experience intestinal damage when they consume gluten, which is found in wheat along with other cereal grains. Elimination of this allergenic protein is the primary treatment for celiac disease.

The children followed in the study had been placed on a gluten-free diet for an average of 2.4 years. Approximately 90 percent of the patients displayed excellent adherence to their gluten-free diet.

 To assess what affect the diet had on the patients’ intestinal health, the children underwent biopsy and endoscopy at least twice during the study period: at the point of disease diagnosis and after one year on a gluten-free diet. The biopsies were conducted to investigate new and persistent symptoms, or in response to abnormal test results.

The study was specifically looking for patients with gluten-induced damage to intestinal cells, which was persistent despite adherence to a gluten-free diet. Laboratory tests are the most commonly-applied diagnostic tool to assess healing in the clinical setting, compared to biopsy and endoscopy.

The researchers found that 29 percent of children showed persistent celiac enteropathy, based on biopsy results. What’s more, this enteropathy could not be predicted based on symptoms or lab tests alone.

“While the long-term effects are not known, persistent enteropathy may predispose pediatric patients with celiac disease to future complications and suboptimal growth,” said Leonard. “These findings suggest the need not only for a baseline endoscopy to confirm the diagnosis of celiac disease but also consideration of a repeat biopsy to evaluate for remission.”