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Coeliac Disease, Microscopic Colitis and Exclusion Diets—a Commemorative Issue in Honour of Dr. Fernando Fernández-Bañares

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutritional Immunology".

Deadline for manuscript submissions: 15 November 2024 | Viewed by 17108

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Dr. Maria Esteve

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Gastroenterology Department, Hospital Universitari Mútua Terrassa, CIBEREHD, 08221 Barcelona, Spain
Interests: gastrointestinal disorders; celiac disease; inflammatory bowel disease; Crohn’s disease; gluten-free diet; malnutrition

Special Issue Information

Dear Colleagues,

This Special Issue is made in honour of Dr. Fernando Fernández-Bañares, who passed away on June 13, 2023, at the age of 64. He became a world-renowned expert for his work on celiac disease and microscopic colitis. He also had profound knowledge of the mechanisms of maldigestion and malabsorption of carbohydrates and wrote an excellent critical analysis about the diagnostic test for these entities. In 1999, he described the first cohort of patients with microscopic colitis in the population of Terrassa (Spain), and thanks to his continuous research in this field, he published data on the evolution of the prevalence of this disease over three decades. He was the coordinator of the Spanish group of microscopic colitis and a very recognized member of the European microscopic colitis group (EMCG). In recent years, he developed a research line that demonstrated the usefulness of duodenal lymphocyte subpopulation pattern assessed via flow cytometry for the diagnosis of celiac disease, especially in difficult cases.

Intestinal homeostasis is the result of a delicate interrelation between food, the microbiota and mucosa-associated immune system. The dysregulation of this complex interplay leads to different forms of intestinal inflammation, such as celiac disease or inflammatory bowel disease, including microscopic colitis. The differential diagnosis with functional disorders of the intestine is not always easy due to the overlap of various entities with poorly defined limits. An example may be of the overlap between the so-called "low-grade celiac disease" or "celiac lite", which is often confused with non-celiac gluten sensitivity. Exclusion diets and microbiota modulation have been proposed as the therapies for many of these entities.

This issue provides a good opportunity to publish the results of research work developed by some of the colleagues of Dr. Fernando Fernández-Bañares in the field of nutrition, restrictive diets (lactose, fructose–sorbitol, gluten-free, FODMAPS, etc.), coeliac disease, intestinal inflammation and functional disorders. This is surely one of the best tributes that can be offered to him.

Dr. Maria Esteve
Guest Editor

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Keywords

malnutrition
coeliac disease
gluten-free diet
restrictive diets
carbohydrate malabsorption
microscopic colitis

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Research

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17 pages, 809 KiB

Open AccessArticle

Knowledge Gaps in Gluten-Free Diet Awareness among Patients and Healthcare Professionals: A Call for Enhanced Nutritional Education

by Paula Crespo-Escobar, Maialen Vázquez-Polo, Maria van der Hofstadt, Concepción Nuñez, Miguel A. Montoro-Huguet, Itziar Churruca and Edurne Simón

Nutrients 2024, 16(15), 2512; https://doi.org/10.3390/nu16152512 - 1 Aug 2024

Viewed by 1200

Abstract

Diet is the only treatment for celiac disease (CeD), and good adherence to a gluten-free diet (GFD) is the only way to ensure complete remission and to prevent complications. Limited education about the disease and a GFD is an attributing factor to inadequate adherence. Thus, our aim was to assess the current knowledge about a GFD and the clinical monitoring of adherence to the diet among CeD people and HCPs. Specific questionnaires were designed and distributed to assess the knowledge of CeD people (Q1 questionnaire) (n = 2437) and to analyze the follow-up of the disease from the perspective of patients (Q2 questionnaire) (n = 1294) and HCPs (Q3 questionnaire) (n = 346). Two-thirds of HCPs specialized in pediatric care, while one-third did so in adult care. In CeD people, general questions regarding food classification and cross-contamination are well understood. When patients have doubts, 51.4% reported using the Internet and social networks. Thus, it is crucial that resources like social media are reliable and provide valuable information. Q3 revealed the lack of time to follow up the diet after diagnosis (48% of HCPs allocate < 15 min), the interest in further training, and the need for a professional specialized in diets within the healthcare system. In conclusion, it is essential to enhance nutritional education to increase awareness of a GFD. Full article

(This article belongs to the Special Issue Coeliac Disease, Microscopic Colitis and Exclusion Diets—a Commemorative Issue in Honour of Dr. Fernando Fernández-Bañares)

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16 pages, 873 KiB

Open AccessArticle

Compliance and Attitudes towards the Gluten-Free Diet in Celiac Patients in Italy: What Has Changed after a Decade?

by Federica Fiori, Giulia Bravo, Susanna Neuhold, Giovanni Bartolone, Caterina Pilo, Maria Parpinel and Nicoletta Pellegrini

Nutrients 2024, 16(15), 2493; https://doi.org/10.3390/nu16152493 - 31 Jul 2024

Cited by 1 | Viewed by 1089

Abstract

This study aims were (i) to describe Italian celiac patients who agreed to participate in the latest web survey and their attitudes toward the GF diet (compliance, perceived limitations, and worries) and (ii) to compare the answers given by the 2011 and 2022 responders. The self-administered questionnaire was distributed through the Italian Coeliac Association channels (link on social media, websites, and newsletters) to all of the celiac patients willing to participate in 2011 and 2022 (2427 and 3529 responders who answered the same questions, respectively). Descriptive analyses and the Pearson’s chi-squared test were performed. The responders were 1 to 84 years old and mainly female. The prevalence of adherent patients in 2022 was 91%, with the highest value (94%) in children (≤10 years old) and adolescents (15−17 years old). Overall, young adults were the most worried group. About a decade after the first survey, we observed a decreasing prevalence of transgression events (−5%) and (at least) occasional temptation (−17%), a decreasing prevalence of health-related and general worries, but an increasing prevalence of social life withdrawal. In conclusion, it is important to periodically monitor celiac patients’ compliance and attitudes towards the gluten-free diet. As also highlighted in international guidelines, a reorganization of the diagnosis/follow-up visits, including an expert dietary consultation, is needed. Full article

(This article belongs to the Special Issue Coeliac Disease, Microscopic Colitis and Exclusion Diets—a Commemorative Issue in Honour of Dr. Fernando Fernández-Bañares)

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17 pages, 3273 KiB

Open AccessArticle

γδ+ T-Cells Is a Useful Biomarker for the Differential Diagnosis between Celiac Disease and Non-Celiac Gluten Sensitivity in Patients under Gluten Free Diet

by Albert Martín-Cardona, Anna Carrasco, Beatriz Arau, Judith Vidal, Eva Tristán, Carme Ferrer, Gerardo Gonzalez-Puglia, Natàlia Pallarès, Cristian Tebé, Sergio Farrais, Concepción Núñez, Fernando Fernández-Bañares and Maria Esteve

Nutrients 2024, 16(14), 2294; https://doi.org/10.3390/nu16142294 - 17 Jul 2024

Viewed by 1938

Abstract

Background: The differential diagnosis between patients with celiac disease (CD) and non-celiac gluten sensitivity (NCGS) is difficult when a gluten-free diet (GFD) has been initiated before the diagnostic work-up. Isolated increases in TCRγδ+ and celiac lymphogram (increased TCRγδ+ plus decreased CD3−) may enable differential diagnosis in this challenging clinical setting. This study evaluated: (1) the accuracy of %TCRγδ+ and celiac lymphogram for diagnosing CD before and after GFD and for differentiation with NCGS; (2) TCRγδ+ kinetics at baseline and after starting GFD in both CD and NCGS. Methods: The inclusion criteria were patients with CD (n = 104), NCGS (n = 37), and healthy volunteers (n = 18). An intestinal biopsy for intraepithelial lymphogram by flow cytometry was performed at baseline and after GFD. The optimal cutoff for CD diagnostic accuracy was established by maximizing the Youden index and via logistic regression. Results: %TCRγδ+ showed better diagnostic accuracy than celiac lymphogram for identifying CD before and after GFD initiation. With a cutoff > 13.31, the accuracy for diagnosing CD in patients under GFD was 0.88 [0.80–0.93], whereas the accuracy for diagnosing NCGS (%TCRγδ+ ≤ 13.31) was 0.84 [0.76–0.89]. The percentage of TCRγδ+ cells showed differential kinetics between CD (baseline 22.7% [IQR, 16.4–33.6] vs. after GFD 26.4% [IQR, 17.8–36.8]; p = 0.026) and NCGS (baseline 9.4% [IQR, 4.1–14.6] vs. after GFD 6.4% [IQR, 3.2–11]; p = 0.022). Conclusion: TCRγδ+ T cell assessment accurately diagnoses CD before and after a GFD. Increased TCRγδ+ was maintained in the long term after GFD in CD but not in NCGS. Altogether, this suggests the potential usefulness of this marker for the differential diagnosis of these two entities in patients on a GFD. Full article

(This article belongs to the Special Issue Coeliac Disease, Microscopic Colitis and Exclusion Diets—a Commemorative Issue in Honour of Dr. Fernando Fernández-Bañares)

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8 pages, 235 KiB

Open AccessArticle

Coeliac Disease and Microscopic Colitis: The Largest Study Assessing Prognosis and Risk of Hospital Admission

by Suneil A. Raju, Megan E. Rawcliffe, Freya J. Bowker-Howell, Mohamed G. Shiha, Kamaldeep E. Kaur, Jonathan Griffin, Simon S. Cross and David S. Sanders

Nutrients 2024, 16(13), 2081; https://doi.org/10.3390/nu16132081 - 29 Jun 2024

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Abstract

Microscopic colitis (MC) and coeliac disease (CD) are common associated gastrointestinal conditions. We present the largest study assessing hospitalisation in patients with MC and the effect of a concomitant diagnosis of CD. Data were retrospectively collected between January 2007 and December 2021 from all patients diagnosed with MC and compared to a database of patients with only CD. In total, 892 patients with MC (65% female, median age 65 years (IQR: 54–74 years) were identified, with 6.4% admitted to hospital due to a flare of MC. Patients admitted were older (76 vs. 65 years, p < 0.001) and presented with diarrhoea (87.7%), abdominal pain (26.3%), and acute kidney injury (17.5%). Treatment was given in 75.9% of patients, including intravenous fluids (39.5%), steroids (20.9%), and loperamide (16.3%). Concomitant CD was diagnosed in 3.3% of patients and diagnosed before MC (57 versus 64 years, p < 0.001). Patients with both conditions were diagnosed with CD later than patients with only CD (57 years versus 44 years, p < 0.001). In conclusion, older patients are at a higher risk of hospitalisation due to MC, and this is seen in patients with a concomitant diagnosis of CD too. Patients with MC are diagnosed with CD later than those without. Full article

(This article belongs to the Special Issue Coeliac Disease, Microscopic Colitis and Exclusion Diets—a Commemorative Issue in Honour of Dr. Fernando Fernández-Bañares)

9 pages, 1091 KiB

Open AccessArticle

The Usefulness of Intraepithelial Lymphocyte Immunophenotype Testing for the Diagnosis of Coeliac Disease in Clinical Practice

by Laura Gutiérrez-Rios, Margalida Calafat, Irene Pascual, Cristina Roig, Aina Teniente-Serra, Laia Vergés, Carlos González-Muñoza, Eva Vayreda, Diego Vázquez, Jordi Gordillo, Míriam Mañosa, Consuelo Ramírez, Esther Garcia-Planella, Montserrat Planella and Eugeni Domènech

Nutrients 2024, 16(11), 1633; https://doi.org/10.3390/nu16111633 - 26 May 2024

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Abstract

Background: The diagnosis of coeliac disease (CD) in adults is based on clinical, serological and histological criteria. The inappropriate performance of intestinal biopsies, non-specificity of mild histological lesions and initiation of a gluten-free diet (GFD) before biopsy may hamper the diagnosis. In these situations, determining the intraepithelial lymphogram of the duodenum by flow cytometry (IEL-FC) can be helpful. Objectives: To describe the clinical scenarios in which the IEL-FC is used and its impact on the diagnosis of CD. Methods: All adult patients with suspected CD at three tertiary centres for whom the duodenal histology and IEL-FC were available were identified. Catassi and Fasano’s diagnostic criteria and changes to a CD diagnosis after the IEL-FCs were collected. Results: A total of 348 patients were included. The following indications for an IEL-FC formed part of the initial study for CD (38%): negative conventional work-up (32%), already on a GFD before duodenal biopsies (29%) and refractoriness to a GFD (2%). The IEL-FC facilitated a definitive diagnosis in 93% of patients with an uncertain diagnosis who had had a conventional work-up for CD or who were on a GFD before histology. Conclusions: The IEL-FC facilitates the confirmation or rejection of a diagnosis of CD in clinical scenarios in which a conventional work-up may be insufficient. Full article

(This article belongs to the Special Issue Coeliac Disease, Microscopic Colitis and Exclusion Diets—a Commemorative Issue in Honour of Dr. Fernando Fernández-Bañares)

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15 pages, 1701 KiB

Open AccessArticle

Intraepithelial Lymphogram in the Diagnosis of Celiac Disease in Adult Patients: A Validation Cohort

by Carlota García-Hoz, Laura Crespo, Roberto Pariente, Ana De Andrés, Rafael Rodríguez-Ramos and Garbiñe Roy

Nutrients 2024, 16(8), 1117; https://doi.org/10.3390/nu16081117 - 10 Apr 2024

Cited by 2 | Viewed by 1179

Abstract

Background: Celiac disease is a gluten-related pathology, highly prevalent and heterogeneous in its clinical presentation, which leads to delays in diagnosis and misdiagnosis. The analysis of duodenal intraepithelial lymphocytes (IELs) by flow cytometry (lymphogram) is emerging as a discriminative tool in the diagnosis of various forms of celiac disease (CD). Aims: The aim of this study was to validate IEL lymphogram performance in the largest adult series to our knowledge, in support of its use as a diagnostic tool and as a biomarker of the dynamic celiac process. Methods: This was a retrospective study including 768 adult patients (217 with active CD, 195 on a gluten-free diet, 15 potential CD patients, and 411 non-celiac controls). The IEL subset cut-off values were established to calculate the diagnostic accuracy of the lymphogram. Results: A complete celiac lymphogram profile (≥14% increase in T cell receptor [TCR]γδ IELs and simultaneous ≤4% decrease in surface-negative CD3 [sCD3⁻] IELs) was strongly associated with active and potential forms in over 80% of the confirmed patients with CD, whereas the remaining patients with CD had partial lymphogram profiles (≥14% increase in TCRγδ or ≤4% decrease in sCD3⁻ IELs), with lower diagnostic certainty. None of these patients had a non-celiac lymphogram. Quantifying the TCRγδ versus sCD3⁻ imbalance as a ratio (≥5) is a discriminative index to discard or suspect CD at diagnosis. Conclusions: We have validated the IEL lymphogram’s diagnostic efficiency (79% sensitivity, 98% specificity), with an LR+ accuracy of 36.2. As expected, the increase in TCRγδ IELs is a reliable marker for celiac enteropathy, while changes in sCD3⁻ IEL levels throughout the dynamic CD process are useful biomarkers of mucosal lesions. Full article

(This article belongs to the Special Issue Coeliac Disease, Microscopic Colitis and Exclusion Diets—a Commemorative Issue in Honour of Dr. Fernando Fernández-Bañares)

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12 pages, 5453 KiB

Open AccessArticle

Improving the Diagnosis of Dermatitis Herpetiformis Using the Intraepithelial Lymphogram

by Fernando Fernández-Bañares, Laura Crespo, Montserrat Planella, Sergio Farrais, Sandra Izquierdo, Natalia López-Palacios, Garbiñe Roy, Judith Vidal and Concepción Núñez

Nutrients 2024, 16(2), 232; https://doi.org/10.3390/nu16020232 - 11 Jan 2024

Viewed by 1255

Abstract

Dermatitis herpetiformis is a cutaneous manifestation of celiac disease. Phenotyping of intraepithelial lymphocytes in the small bowel mucosa can strengthen the diagnosis of celiac disease when it is not clear-cut. We aim to evaluate the usefulness of the intraepithelial lymphogram to confirm dermatitis herpetiformis in equivocal cases. We performed a retrospective multicenter study on patients diagnosed with dermatitis herpetiformis and collected data from the intraepithelial lymphogram assessed by flow cytometry. A total of 36 patients were analyzed in relation to the severity of intestinal damage (18 had non-atrophic mucosa) at baseline (N = 28) and/or after the adoption of a gluten-free diet (median follow-up of three years, N = 16). We observed that patients with atrophy more often had positive celiac serology (p = 0.019), celiac clinical symptoms (p = 0.018), and iron-deficiency anemia (p = 0.018), but the severity of skin damage was similar in both groups (p = 0.79). At baseline, increased TCRγδ⁺ cells were present in 94% of patients with atrophy and 67% with non-atrophic lesions (p = 0.13). After a gluten-free diet, increased TCRγδ⁺ cells persisted in 100% and 63% of cases, respectively (p = 0.21). We concluded that increased TCRγδ⁺ cells may be helpful in confirming the diagnosis of dermatitis herpetiformis in equivocal cases, even in patients who were started on a gluten-free diet. Full article

(This article belongs to the Special Issue Coeliac Disease, Microscopic Colitis and Exclusion Diets—a Commemorative Issue in Honour of Dr. Fernando Fernández-Bañares)

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13 pages, 1618 KiB

Open AccessArticle

A Population-Based Cross-Sectional Study of Paediatric Coeliac Disease in Catalonia Showed a Downward Trend in Prevalence Compared to the Previous Decade

by Beatriz Arau, Beatriz Dietl, Emma Sudrià-Lopez, Josefa Ribes, Laura Pareja, Teresa Marquès, Roger Garcia-Puig, Francisco Pujalte, Albert Martin-Cardona, Fernando Fernández-Bañares, Meritxell Mariné, Carme Farré and Maria Esteve

Nutrients 2023, 15(24), 5100; https://doi.org/10.3390/nu15245100 - 13 Dec 2023

Cited by 1 | Viewed by 1716

Abstract

(1) Background: Previous studies showed an increased prevalence and incidence of coeliac disease (CD) over time. The objective is to ascertain whether the CD prevalence in Catalonia (a region of Southern Europe) among children aged 1–5 is as high as previously found in 2004–2009; (2) Methods: From 2013 to 2019, 3659 subjects aged 1–5 years were recruited following the previously used methodology. Factors with a potential impact on CD prevalence were investigated; (3) Results: In 2013–2019, 43/3659 subjects had positive serology, giving a standardised seroprevalence of 12.55/1000 (95% CI: 8.92; 17.40), compared to 23.62 (13.21; 39.40) in 2004–2007. The biopsy-proven crude prevalence was 7.92/1000 (95% CI: 5.50; 11.30), and the crude prevalence based on ESPGHAN criteria was 8.74/1000 (95% CI: 6.20–12.30). In contrast to 2004–2009, we did not find differences in the seroprevalence rates between 1 and 2 years vs. 3 and 4 years of age (age percentage of change −7.0 (−29.5; 22.8) vs. −45.3 (−67.5; −8.0)). Rotavirus vaccination was the most remarkable potential protective factor (48% vs. 9% in 2004–2009; p < 0.0001), but not the time of gluten introduction. (4) Conclusion: The present study did not confirm a worldwide CD prevalence increase and emphasizes the need to perform prevalence studies over time using the same methodology in the same geographical areas. Full article

(This article belongs to the Special Issue Coeliac Disease, Microscopic Colitis and Exclusion Diets—a Commemorative Issue in Honour of Dr. Fernando Fernández-Bañares)

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13 pages, 861 KiB

Open AccessArticle

Rapid Anti-tTG-IgA Screening Test for Early Diagnosis of Celiac Disease in Pediatric Populations

by Irati Mendia, Verónica Segura, Ángela Ruiz-Carnicer, Laura Coto, María Negrete, Joshua C. D. Long, Joaquin Reyes, Benito Amil, Ignacio Salamanca, Isabel Comino, Ángel Cebolla and Carolina Sousa

Nutrients 2023, 15(23), 4926; https://doi.org/10.3390/nu15234926 - 26 Nov 2023

Cited by 1 | Viewed by 1567

Abstract

A large number of patients with celiac disease (CD) remain undiagnosed because they do not fulfill the criteria for entry into the conventional diagnostic workflow. This study evaluated the clinical utility of anti-tissue transglutaminase IgA antibody lateral flow immunoassays (anti-tTG-IgA LFIA) in the undiagnosed-CD-based pediatric population and the impact of a gluten-free diet (GFD) on screening-detected CD. A total of 576 volunteers were tested for anti-tTG-IgA. Gluten consumption habits, CD related symptoms, and risk factors for CD development were evaluated. Volunteers testing positive for anti-tTG-IgA were referred to the conventional CD diagnostic workflow, and the impact of the GFD on health-related quality of life (HR-QoL) was measured. Among them, 13 had a positive anti-tTG-IgA LFIA test result: 11 had confirmed CD (1.91%), one refused confirmatory tests, and another is undergoing diagnosis. Regarding the CD prevalence, no significant differences were observed among risk (1.89%) and symptomatic (2.65%) groups and the entire tested population (1.55%). Rapid anti-tTG-IgA LFIAs could be of clinical utility in primary care for the early identification of children with CD unidentified by the conventional diagnostic workflow. It could potentially reduce the costs of undiagnosed CD, avoiding unnecessary referrals to gastroenterologists, reducing diagnosis delays and long-term problems, and improving patients’ HR-QoL. Full article

(This article belongs to the Special Issue Coeliac Disease, Microscopic Colitis and Exclusion Diets—a Commemorative Issue in Honour of Dr. Fernando Fernández-Bañares)

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17 pages, 2692 KiB

Open AccessReview

Microscopic Colitis and Celiac Disease: Sharing More than a Diagnostic Overlap

by Ana María González-Castro, Fernando Fernández-Bañares, Yamile Zabana, Georgina Farago-Pérez, Jonathan Ortega-Barrionuevo, Elba Expósito and Danila Guagnozzi

Nutrients 2024, 16(14), 2233; https://doi.org/10.3390/nu16142233 - 11 Jul 2024

Viewed by 1048

Abstract

Microscopic colitis (MC) is an emergent group of chronic inflammatory diseases of the colon, and celiac disease (CD) is a chronic gluten-induced immune-mediated enteropathy affecting the small bowel. We performed a narrative review to provide an overview regarding the relationship between both disorders, analyzing the most recent studies published at the epidemiological, clinical and pathophysiological levels. In fact, MC and CD are concomitantly prevalent in approximately 6% of the cases, mainly in the subset of refractory patients. Thus, physicians should screen refractory patients with CD against MC and vice versa. Both disorders share more than a simple epidemiological association, being multifactorial diseases involving innate and adaptive immune responses to known or unknown luminal factors based on a rather common genetic ground. Moreover, autoimmunity is a shared characteristic between the patients with MC and those with CD, with autoimmunity in the latter being quite well-established. Furthermore, CD and MC share some common clinical symptoms and risk factors and overlap with other gastrointestinal diseases, but some differences exist between both disorders. More studies are therefore needed to better understand the complex mechanisms involving the common pathogenetic ground contributing to the CD and MC epidemiological association. Full article

(This article belongs to the Special Issue Coeliac Disease, Microscopic Colitis and Exclusion Diets—a Commemorative Issue in Honour of Dr. Fernando Fernández-Bañares)

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22 pages, 2796 KiB

Open AccessSystematic Review

Efficacy of Dietary Therapy for Eosinophilic Esophagitis in Children and Adults: An Updated Systematic Review and Meta-Analysis

by Ángel Arias, Antonio Tejera-Muñoz, Lucía Gutiérrez-Ramírez, Javier Molina-Infante and Alfredo J. Lucendo

Nutrients 2024, 16(14), 2231; https://doi.org/10.3390/nu16142231 - 11 Jul 2024

Viewed by 1604

Abstract

Background: Several dietary approaches have been used to induce remission in patients with eosinophilic esophagitis (EoE), yielding varied results. Methods: We searched the MEDLINE, EMBASE, and Scopus databases up to May 2024 to identify studies including dietary interventions for EoE used as monotherapy. Summary estimates with 95% CIs for achieving <15 eosinophils/HPF were calculated for each approach. Fixed or random effects models were used depending on heterogeneity (I²); publication bias risks were assessed using funnel plot analyses. Subgroup analyses results were compared using meta-regression. Results: Forty-three studies with 2825 patients were included in quantitative summaries. The overall rate of histologic remission was 60.6% (95% CI, 54.6–66.5%). Effectiveness rates were 94.5% (95% CI, 92.3–96.4%) for elemental diets, 63.9% (95% CI, 58.5–69.2%) for six-food elimination diets, 54.7% (95% CI, 45.7–63.6%) for four-food elimination diets, 44.3% (95% CI, 36.1–52.8%) for two-food elimination diets, 46.4% (95% CI, 40–52.9%) for one-food elimination diets, and 39.5% (95% CI, 30.3–49.2%) for allergy testing-directed food elimination diets. Overall, superior efficacy was noted in children than in adults and in retrospective compared to prospective studies. Conclusion: Diet therapy remains an effective therapeutic asset for pediatric and adult patients with EoE, with increasing efficacy noted as the levels of dietary restriction increase. Full article

(This article belongs to the Special Issue Coeliac Disease, Microscopic Colitis and Exclusion Diets—a Commemorative Issue in Honour of Dr. Fernando Fernández-Bañares)

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11 pages, 977 KiB

Open AccessSystematic Review

Efficacy of a Low-FODMAP Diet for Coeliac Patients with Persistent IBS-like Symptoms despite a Gluten-Free Diet: A Systematic Review

by Francesca Lusetti, Annalisa Schiepatti, Davide Scalvini, Stiliano Maimaris and Federico Biagi

Nutrients 2024, 16(7), 1094; https://doi.org/10.3390/nu16071094 - 8 Apr 2024

Cited by 1 | Viewed by 1551

Abstract

Background: Persistent symptoms in coeliac disease (CD) can be due to not only poor gluten-free diet (GFD) adherence and complications of CD, but also functional gastrointestinal disorders such as irritable bowel syndrome (IBS). Although the role of a low fermentable oligo-, di-, and monosaccharides and polyols (FODMAP) diet is well-established in IBS, little data are available on its role in coeliac patients with persistent IBS-like symptoms despite a GFD. Methods: We systematically reviewed the literature in accordance with the PRISMA guidelines for studies evaluating the role of FODMAPs and/or a low-FODMAP diet in coeliac patients with persistent symptoms. PubMed and Embase were searched from inception to 16 January 2024 for eligible full-text papers. The study protocol was registered on Open Science Framework. Results: A total of 239 records were identified, and six papers were included. Of these, four were interventional studies comparing a low-FODMAP GFD to a regular GFD for persistent symptoms in 115 total coeliac patients (two randomized controlled trials and two open-label studies). A low-FODMAP GFD for a minimum of 4 weeks was significantly more effective than a regular GFD in reducing symptoms (p < 0.05 in 3/4 studies). Dietary FODMAP content of a conventional GFD was significantly lower than that of non-coeliac patients on a gluten-containing diet (both p < 0.05), especially regarding high-FODMAP grain products. However, coeliac patients consumed more servings of fruits/vegetables high in FODMAP. No relationship between FODMAP intake and persistence of symptoms was reported. Conclusions: A low-FODMAP diet may be beneficial for uncomplicated celiac patients with persistent IBS-like symptoms despite strict adherence to a GFD. Full article

(This article belongs to the Special Issue Coeliac Disease, Microscopic Colitis and Exclusion Diets—a Commemorative Issue in Honour of Dr. Fernando Fernández-Bañares)

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