title: Gluten-free diet does not influence the occurrence and the Th1/Th17-Th2 nature of immune-mediated diseases in patients with coeliac disease.
abstract: BACKGROUND
  Coeliac disease (CD) is the most common Th1-mediated enteropathy, frequently associated with other immune-mediated disorders (IMD).
  
  
  OBJECTIVE
  To evaluate: (1) the prevalence of IMD at the time of and after CD diagnosis; (2) a possible change in immune response to gluten free diet (GFD); (3) the potential role of GFD in reducing and/or preventing IMD in CD.
  
  
  METHODS
  Prospective study including all consecutive adult CD patients who underwent investigations for Th1-Th17/Th2-IMD at the time of CD diagnosis and after a 5-year follow-up period.
  
  
  RESULTS
  1255 CD were enrolled. Of these, 257 patients (20.5%) showed IMD at the time of CD diagnosis, with 58.4% presenting a Th1/Th17-IMD. After a 5-year follow-up period, 682 patients (54.3%) showed new IMD despite GFD. Of these, 57.3% presented a Th1/Th17-IMD and 42.7% a Th2-IMD (p=0.8). When compared the prevalence of each type of IMD before and after CD diagnosis, we did not identify any significant "switch" from Th1/Th17- to Th2-IMD or vice versa. The number of patients with Th1/Th17- and/or Th2-IMD increased during the GFD period (20.5% vs 54.3%; p<0.01; OR 1.9).
  
  
  CONCLUSIONS
  The prevalence of IMD at the time of CD diagnosis is high and it seems to increase in the follow-up period despite GFD.
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Italy. Electronic address: nicola.imperatore@alice.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Imperatore
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rispo
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Capone
authors.affiliation: Department of Education and Professional Studies, King's College London, London, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: Donetto
authors.affiliation: Surgical Endoscopy, Department of Clinical Medicine and Surgery, University Federico II of Naples, Italy.
authors.forename: Giovanni Domenico
authors.initials: GD
authors.lastname: De Palma
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Gerbino
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Italy.
authors.forename: Matilde
authors.initials: M
authors.lastname: Rea
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Caporaso
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Tortora
mesh_terms: D000293:Adolescent; D000328:Adult; D001327:Autoimmune Diseases / Q000453:epidemiology*; D002446:Celiac Disease / Q000178:diet therapy* / Q000453:epidemiology* / Q000276:immunology*; D055050:Diet, Gluten-Free; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D011446:Prospective Studies; D006377:T-Lymphocytes, Helper-Inducer / Q000276:immunology*; D055815:Young Adult
keywords: Autoimmunity; Coeliac disease; Gluten; Immuno-mediated diseases; Th1; Th17; Th2