Benefits of a gluten-free diet for asymptomatic patients with serologic markers of celiac disease.
OBJECTIVE
We investigated whether screen-detected and apparently asymptomatic adults with endomysial antibodies (EmA) benefit from a gluten-free diet (GFD).


METHODS
We performed a prospective trial of 3031 individuals at risk for celiac disease based on screens for EmA. Of 148 seropositive individuals, 40 fulfilled inclusion criteria and were assigned randomly to groups placed on a GFD or gluten-containing diets. We evaluated ratios of small-bowel mucosal villous height:crypt depth, serology and laboratory test results, gastrointestinal symptom scores, physiologic well-being, perception of health by a visual analog scale, bone mineral density, and body composition at baseline and after 1 year. Thereafter, the group on the gluten-containing diet started a GFD and was evaluated a third time; subjects in the GFD group remained on this diet.


RESULTS
After 1 year on the GFD, the mean mucosal villous height:crypt depth values increased (P < .001), levels of celiac-associated antibodies decreased (P < .003), and gastrointestinal symptoms improved to a greater extent than in patients on gluten-containing diets (P = .003). The GFD group also had reduced indigestion (P = .006), reflux (P = .05), and anxiety (P = .025), and better health, based on the visual analog scale (P = .017), than the gluten-containing diet group. Only social function scores improved more in the gluten-containing diet group than in the GFD group (P = .031). There were no differences between groups in laboratory test results, bone mineral density, or body composition. Most measured parameters improved when patients in the gluten-containing diet group were placed on GFDs. No subjects considered their experience to be negative and most expected to remain on GFDs.


CONCLUSIONS
GFDs benefit asymptomatic EmA-positive patients. The results support active screening of patients at risk for celiac disease. Clinicaltrials.gov no: NCT01116505.
Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.
Kalle
K
Kurppa
Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland.
Aku
A
Paavola
Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland.
Pekka
P
Collin
UKK Institute, Tampere, Finland.
Harri
H
Sievänen
Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.
Kaija
K
Laurila
Tampere School of Health Sciences, University of Tampere and Tampere University Hospital, Tampere, Finland.
Heini
H
Huhtala
Research Program Unit, Immunobiology and Haartman Institute, Department of Medical Genetics, University of Helsinki, Helsinki, Finland.
Päivi
P
Saavalainen
Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.
Markku
M
Mäki
Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland; Seinäjoki Central Hospital, Seinäjoki, Finland. Electronic address: katri.kaukinen@uta.fi.
Katri
K
Kaukinen
D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001823:Body Composition; D015519:Bone Density; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis / Q000178:diet therapy* / Q000235:genetics / Q000276:immunology; D055050:Diet, Gluten-Free; D005260:Female; D005387:Finland; D019204:GTP-Binding Proteins; D006683:HLA-DQ Antigens / Q000235:genetics; D006801:Humans; D007413:Intestinal Mucosa / Q000276:immunology / Q000473:pathology; D007421:Intestine, Small / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011788:Quality of Life; D012698:Serologic Tests; D013997:Time Factors; D011503:Transglutaminases / Q000276:immunology*; D016896:Treatment Outcome; D055815:Young Adult
D001323:Autoantibodies; D015415:Biomarkers; D006683:HLA-DQ Antigens; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins
GSRS; Gastrointestinal Endoscopy; Serology Test; VAS