Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2017; 23(15): 2635-2639
Published online Apr 21, 2017. doi: 10.3748/wjg.v23.i15.2635
Dietary compliance in celiac disease
Hugh James Freeman
Hugh James Freeman, Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, BC V6T 1Z4, Canada
Author contributions: Freeman HJ solely contributed to this paper.
Conflict-of-interest statement: The author has no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Hugh James Freeman, Professor, Department of Medicine (Gastroenterology), University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 1Z4, Canada. hugfree@shaw.cac
Telephone: +1-604-8227216
Received: December 30, 2016
Peer-review started: January 3, 2017
First decision: January 19, 2017
Revised: January 24, 2017
Accepted: March 20, 2017
Article in press: March 20, 2017
Published online: April 21, 2017
Abstract

Celiac disease is an immune-mediated disorder that causes severe architectural disturbance in the small intestinal mucosa of genetically-predisposed individuals. Impaired absorption of multiple nutrients results and diarrhea and weight loss develop. Evidence has accumulated that a strict gluten-free diet can result in resolution of diarrhea, weight gain and normalization of nutrient malabsorption. In addition, histopathological changes also normalize, but this histopathological response appears to be time-dependent, sex-dependent and age-dependent. Compliance to a gluten-free diet is difficult and costly resulting in poor compliance and only a limited clinical response. This poses a risk for later long-term complications, including malignancy. A major practical clinical problem is the assessment of compliance to the gluten-free diet. Although symptoms may resolve and serological antibody markers may improve, multiple studies have documented ongoing architectural disturbance and inflammatory change, and with these continued inflammatory changes, a persistent risk for long-term complications. Recent immunological studies have suggested that peptides can be detected in both urine and fecal specimens that may be indicative of limited compliance. At the same time, multiple biopsy studies have demonstrated that complete normalization of the mucosa may occur in some patients within 6 mo of initiation of a gluten-free diet, but more often, up to 2 years or more may be required before repeated biopsies eventually show mucosal recovery and mucosal healing.

Keywords: Gluten-free diet, Compliance, Dietary recall, Celiac disease, Fecal immunoreactive peptides, Tissue transglutaminase antibodies

Core tip: Celiac disease is an immune-mediated disorder that improves with a strict gluten-free diet. Dietary compliance is essential for symptom resolution and reduction of the risk of long-term complications, including malignancy. Recent evidence suggests that resolution of symptoms and normalization of serological antibody markers on a gluten-free diet occurs, but mucosal inflammatory changes may persist, a critical risk factor for long-term complications. Several recent biopsy studies have documented that the small intestinal mucosa in adult celiac disease may completely normalize within months, but most require up to 2 years or more to demonstrate mucosal recovery and healing. Histopathological rates of resolution on a gluten-free diet appear to be time-dependent, sex-dependent with higher rates in females, and age-dependent, with lower rates in the very elderly.