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Trial Lecture – time and place
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Adjudication committee
- First opponent: Researcher Stine Størsrud, University of Gothenburg, Sweden
- Second opponent: Associate Professor Rasmus Goll, The Arctic University of Norway,
- Third member and chair of the evaluation committee: Professor II Knut Jørgen Labori, University of Oslo
Chair of the Defence
Professor Emeritus Frode Vartdal, University of Oslo
Principal Supervisor
Associate Professor Christine Henriksen, University of Oslo
Summary
In most patients with celiac disease the small intestinal inflammation and symptoms are reversed on a gluten-free diet. However, persistent symptoms seem to be common, even in patients with biopsy-proven remission of the disease. The persistent symptoms resemble irritable bowel syndrome (IBS). In her doctoral thesis Persistent gastrointestinal symptoms in celiac disease Frida van Megen and co-workers aimed to study the prevalence of persistent gastrointestinal symptoms among celiac patients. Secondly, they aimed to investigate whether a low FODMAP diet may improve symptoms, thirdly to investigate gluten immunogenic peptides (GIP) in urine and feces as a method for dietary adherence, and finally, to assess the nutritional adequacy of a gluten-free diet.
In a survey among 4000 celiac patients in Norway they found a prevalence of persistent symptoms of 40%. A low FODMAP diet is commonly used in the treatment of IBS. A low FODMAP diet significantly reduced IBS-like symptoms in a randomized controlled trial among 70 celiac patients. Furthermore, gluten-free diet adherence was significantly higher when measured by GIP in feces compared to the simple questionnaire Celiac Disease Adherence Test. GIP may be a useful biomarker for gluten consumption. Lastly, they found that women with celiac disease had a lower intake of fiber, and a higher intake of total- and saturated fat compared to the general population.
In summary, there was a high prevalence of persistent symptoms among treated celiac patients. The efficacy of a low FODMAP diet extends beyond IBS, and should be offered to celiac patients with ongoing symptoms despite biopsy-proven remission. Gluten exposure as a cause of persistent symptoms should first be ruled out, and the efficacy of GIP as a simple non-invasive tool for the assessment of gluten-free diet adherence should be further explored. Lastly, celiac patients need healthy diet advice in addition to instructions in the gluten-free diet.
Additional information
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