engleski

The effect of gluten-free diet in children with coeliac disease

Coeliac disease (CD) is a life-long disorder with gluten-induced manifestations in different organs. Gluten-free diet (GFD) is required for normal physical development but also to prevent different malignant and non-malignant complications. Children with coeliac disease (CD) have an increased number of chromosome aberrations in peripheral blood lymphocytes that may lead to predisposition to cancer in CD patients. Concerning adherence to gluten-free diet many longitudinal studies have been performed so far but the results are not consistent regarding the influence on growth and development. Two studies were conducted in Children's Hospital Zagreb with the following aims: 1. to follow a group of children with CD in whom the initial frequency of chromosome aberrations at diagnosis was known and to measure the same variable after a minimum of 2 years on a gluten-free diet, and 2. to investigate the influence of the adherence to GFD in our patients in respect to their body mass and height, presence of anaemia and other signs and symptoms. Methods. Chromosome aberrations in peripheral blood lymphocytes were determined in 17 patients with CD, before and after at least 24 months of a gluten free diet (mean, 33 months), and in 15 healthy children. The differences in the frequency of aberrations were analyzed by Mann-Whitney U test and Wilcoxon matched-pairs signed-ranks test. Also, 71 patients with coeliac disease (mean age 12 y ; average time after diagnosis 9 y) underwent physical examination and were offered a questionnaire. Their blood was taken to analyse endomysial antibodies (EMA), hemoglobin and red blood cell count. Adherence to GFD was established according to the questionnaire and the results of EMA testing. Statistical differences were analysed by &#61539; 2-test and Mann-Whitney U Wilcoxon test. Results. Twelve patients adhered to the diet and had a significantly lower frequency of chromosome aberrations than 5 patients not following the diet (0.16 v. 1.2% ; p=0.03), while at presentation there had been no difference (1.54 v. 1.2% ; p=0.09). The frequency of aberrations at follow-up in patients who adhered to diet was significantly lower than at presentation (1.54 v. 0.16% ; p=0.02) and remained unchanged in patients who did not adhere to diet (1.2 v. 1.2% ; p=1). After at least 24 months of a gluten free diet, children with CD did not differ from healthy control subjects (0.16 v. 0.27% ; p=0.54), while children not following the diet had an increased frequency of aberrations (1.2 v. 0.27% ; p=0.05). In the other study, 42 patients (59.1%) were on a strict GFD according to the questionnaire (4 or 9.5% EMA positive), 19 (26.8%) were taking small amounts of gluten (5 or 26.3% EMA positive) while 10 (14.1%) were not on a diet (all EMA positive). Although patients on a strict GFD were the tallest there was no significant difference in body height in respect to the adherence to GFD. Patients on a strict diet had higher average body mass than those not adhering to diet (p=0.05). Also their average hemoglobin and mean cell hemoglobin (MCH) level were significantly higher (p=0.05 and p<0.05, respectively). Besides chronic fatigue in patients on a parcial diet (p=0.05), groups did not differ significantly in frequency of symptoms. Anaemia was recorded only in patients who were taking gluten (p<0.01) as well as delayed puberty (p<0.05). &#8220; Non-compliers&#8221; found a diet to be a burden in life more often than &#8220; compliers&#8221; (p<0.01, df=4) and seemed not to visit a gastroenterologist on a regular basis (p<0.01, df=2). Conclusions. The frequency of chromosome aberrations in peripheral blood lymphocytes of patients with CD decreased significantly on a gluten-free diet. We conclude that genomic instability is a secondary phenomenon, possibly caused by chronic intestinal inflammation. Almost half (46.4%) of coeliac patients in this study were taking gluten. EMA was not indicative of the occasional intake of small amounts of gluten. Patients with coeliac disease are likely to abandon gluten-free diet without having major symptoms and thus increase the risk of developing complications later in life. An active attitude is required in the follow-up of patients with CD including regular visits to a gastroenterologist, good knowledge of the disease and availability of the safe GFD.

coeliac disease; gluten-free diet; children

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