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Characteristics of Patients Who Avoid Wheat and/or Gluten in the Absence of Celiac Disease

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Abstract

Background

Gastrointestinal symptoms that respond to the removal of wheat and/or gluten are becoming more common. Patients who avoid wheat and/or gluten (PWAWG) are a heterogeneous group and predominantly self-diagnosed prior to presenting for clinical evaluation.

Specific aim

We characterized PWAWGs seen at a tertiary care referral center and compared them to patients with celiac disease (CD) and subjects in the National Health and Nutrition examination survey (NHANES).

Methods

This was a cross-sectional study evaluating patients seen by four gastroenterologists at a CD referral center. Baseline characteristics, laboratory values, and medical comorbidities were compared to CD patients who presented at the same center and subjects enrolled in NHANES.

Results

Eighty-four PWAWGs were identified and compared to 585 CD patients and 2,686 NHANES patients. Thirty-two alternative diagnoses were made in 25 (30 %) PWAWGs, including small intestinal bacterial overgrowth and fructose/lactose intolerance. When compared to patients with CD, PWAWGs had similar body mass index (BMI, 23.1 vs. 23.5, p = 0.54) and mean hemoglobin value (13.4 vs. 13.3, p = 0.6). When compared to male and female patients in NHANES, BMI, folate, and mean hemoglobin values were lower in PWAWGs. Both male and female PWAWGs had a lower prevalence of hypertension.

Conclusion

While there are similarities between CD and PWAWGs that could possibly be due to shared HLA haplotypes or an effect of the gluten-free diet, alternative diagnoses are common in these patients. PWAWGs have a similar cardiovascular profile as CD patients in terms of lower BMI and lower prevalence of hypertension.

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References

  1. Rubio-Tapia A, Ludvigsson JF, Brantner TL, et al. The prevalence of celiac disease in the United States. Am J Gastroenterol. 2012;107:1538–1544.

    Article  PubMed  Google Scholar 

  2. Ferch CC, Chey WD. Irritable bowel syndrome and gluten sensitivity without celiac disease: separating the wheat from the chaff. Gastroenterology. 2012;142:664–673.

    Article  PubMed  Google Scholar 

  3. Ludvigsson JF, Leffler DA, et al. The Oslo definitions for coeliac disease and related terms. Gut. 2013;62:43–52.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Di Sabatino A, Corazza GR. Nonceliac gluten sensitivity: sense or sensibility? Ann Intern Med. 2012;156:309–311.

    Article  PubMed  Google Scholar 

  5. Troncone R, Jabri B. Coeliac disease and gluten sensitivity. J Intern Med. 2011;269:582–590.

    Article  CAS  PubMed  Google Scholar 

  6. Sapone A, Bai JC, Ciacci C, et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med. 2012;10:13.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Lundin KE, Alaedini A. Non-celiac gluten sensitivity. Gastrointest Endosc Clin N Am. 2012;22:723–734.

    Article  PubMed  Google Scholar 

  8. Wahnschaffe U, Schulzke JD, Zeitz M, Ullrich R. Predictors of clinical response to gluten-free diet in patients diagnosed with diarrhea-predominant irritable bowel syndrome. Clin Gastroenterol Hepatol. 2007;5:844–850.

    Article  PubMed  Google Scholar 

  9. Biesiekierski JR, Newnham ED, Irving PM, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol. 2011;106:508–514.

    Article  CAS  PubMed  Google Scholar 

  10. Brottveit M, Vandvik PO, Wojniusz S, et al. Absence of somatization in non-coeliac gluten sensitivity. Scand J Gastroenterol. 2012;47:770–777.

    Article  CAS  PubMed  Google Scholar 

  11. Carroccio A, Mansueto P, Iacono G, et al. Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am J Gastroenterol. 2012;107:1898–1906.

    Article  PubMed  Google Scholar 

  12. Biesiekierski JR, Peters SL, Newnham ED, et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology. 2013;145:320.e3–328.e3. doi:10.1053/j.gastro.2013.04.051.

  13. Vazquez-Roque MI, Camilleri M, Smyrk T, et al. A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea: effects on bowel frequency and intestinal function. Gastroeneterology. 2013;144:903–911.

    Article  CAS  Google Scholar 

  14. Cooper BT, Holmes GK, Ferguson R, et al. Gluten-sensitive diarrhea without evidence of celiac disease. Gastroenterology. 1981;81:192–194.

    CAS  PubMed  Google Scholar 

  15. Brar P, Kwon GY, Holleran S, et al. Change in lipid profile in celiac disease: beneficial effect of gluten-free diet. Am J Med. 2006;119:786–790.

    Article  CAS  PubMed  Google Scholar 

  16. Kabbani TA, Kelly CP, Betensky RA, et al. Patients with celiac disease have a lower prevalence of non-insulin-dependent diabetes mellitus and metabolic syndrome. Gastroenterology. 2013;144:912.e1–917.e1. doi:10.1053/j.gastro.2013.01.033.

  17. Cheng J, Brar PS, Lee AR, Green PH. Body mass index in celiac disease: beneficial effect of a gluten-free diet. J Clin Gastroenterol. 2010;44:267–271.

    Article  PubMed  Google Scholar 

  18. Mubarak A, Wolters VM, Gerritsen SA, Gmelig-Meyling FH, Ten Kate FJ, Houwen RH. A biopsy is not always necessary to diagnose celiac disease. J Pediatr Gastroenterol Nutr. 2011;52:554.

    Article  PubMed  Google Scholar 

  19. Thompson T, Dennis M, Higgins LA, Lee AR, Sharrett MK. Gluten-free diet survey: are Americans with coeliac disease consuming recommended amounts of fibre, iron, calcium and grain foods? J Hum Nutr Diet. 2005;18:163–169.

    Article  CAS  PubMed  Google Scholar 

  20. Hallert C, Grant C, Grehn S, et al. Evidence of poor vitamin status in coeliac patients on a gluten-free diet for 10 years. Aliment Pharmacol Ther. 2002;16:1333–1339.

    Article  CAS  PubMed  Google Scholar 

  21. Hallert C, Svensson M, Tholstrup J, Hultberg B. Clinical trial: B vitamins improve health in patients with coeliac disease living on a gluten-free diet. Aliment Pharmacol Ther. 2009;29:811–816.

    Article  CAS  PubMed  Google Scholar 

  22. Howard MR, Turnbull AJ, Morley P, Hollier P, Webb R, Clarke A. A prospective study of the prevalence of undiagnosed coeliac disease in laboratory defined iron and folate deficiency. J Clin Pathol. 2002;55:754–757.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Ohlund K, Olsson C, Hernell O, Ohlund I. Dietary shortcomings in children on a gluten-free diet. J Hum Nutr Diet. 2010;23:294–300.

    Article  CAS  PubMed  Google Scholar 

  24. Wild D, Robins GG, Burley VJ, Howdle PD. Evidence of high sugar intake, and low fibre and mineral intake, in the gluten-free diet. Aliment Pharmacol Ther. 2010;32:573–581.

    Article  CAS  PubMed  Google Scholar 

  25. Rampertab SD, Pooran N, Brar P, Singh P, Green PH. Trends in the presentation of celiac disease. Am J Med. 2006;119:355e9–355e14.

    Article  Google Scholar 

  26. Hernandez L, Green PH. Extraintestinal manifestations of celiac disease. Curr Gastroenterol Rep. 2006;8:383–389.

    Article  PubMed  Google Scholar 

  27. DiGiacomo DV, Tennyson CA, Green PH, Demmer RT. Prevalence of gluten-free diet adherence among individuals without celiac disease in the USA: results from the Continuous National Health and Nutrition Examination Survey 2009–2010. Scand J Gastro. 2013;48:921–925. doi:10.3109/00365521.2013.809598.

  28. Coburn JA, Vande Voort JL, Lahr BD, et al. Human leukocyte antigen genetics and clinical features of self-treated patients on a gluten-free diet. J Clin Gastroenterol. 2013;47:828–833. doi:10.1097/MCG.0b013e31828f531c.

    Google Scholar 

  29. Green PH, Jabri B. Coeliac disease. Lancet. 2003;362:383–391.

    Article  CAS  PubMed  Google Scholar 

  30. Brottveit M, Raki M, Bergseng E, et al. Assessing possible celiac disease by an HLA-DQ2-gliadin tetramer test. Am J Gastroenterol. 2011;106:1318–1324.

    Article  CAS  PubMed  Google Scholar 

  31. Thewissen BG, Pauly A, Calus I, et al. Inhibition of angiotensin I-converting enzyme by wheat gliadin hydrolysates. Food Chem. 2011;127:1653–1658.

    Article  CAS  Google Scholar 

  32. Behall KM, Scholfield DJ, Hallfrisch J. Whole-grain diets reduce blood pressure in mildly hypercholesterolemic men and women. J Am Diet Assoc. 2006;106:1445–1449.

    Article  PubMed  Google Scholar 

  33. Tighe P, Duthie G, Vaughan N, et al. Effect of increased consumption of whole-grain foods on blood pressure and other cardiovascular risk markers in healthy middle-aged persons: a randomized controlled trial. Am J Clin Nutr. 2010;92:733–740.

    Article  CAS  PubMed  Google Scholar 

  34. Gaesser GA, Siddhartha AS. Gluten-free diet: imprudent dietary advice for the general population? J Acad Nutr Diet. 2012;112:1330–1333.

    Article  PubMed  Google Scholar 

  35. Perrier C, Corthesy B. Gut permeability and food allergies. Clin Exp Allergy. 2011;41:20–28.

    Article  CAS  PubMed  Google Scholar 

  36. Vanga R, Leffler D. Gluten sensitivity: not celiac and not certain. Gastroenterology. 2013;145(2):276–279. doi:10.1053/j.gastro.2013.06.027.

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Authors and Affiliations

  1. Department of Medicine, Celiac Disease Center, Columbia University, 180 Fort Washington Avenue, Suite 936, New York, NY, 10032, USA

    Anna Tavakkoli, Suzanne K. Lewis, Christina A. Tennyson, Benjamin Lebwohl & Peter H. R. Green

  2. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    Benjamin Lebwohl

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  1. Anna Tavakkoli
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  2. Suzanne K. Lewis
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  3. Christina A. Tennyson
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  4. Benjamin Lebwohl
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  5. Peter H. R. Green
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Correspondence to Peter H. R. Green.

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Tavakkoli, A., Lewis, S.K., Tennyson, C.A. et al. Characteristics of Patients Who Avoid Wheat and/or Gluten in the Absence of Celiac Disease. Dig Dis Sci 59, 1255–1261 (2014). https://doi.org/10.1007/s10620-013-2981-6

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  • DOI: https://doi.org/10.1007/s10620-013-2981-6

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