Introduction: The role of a gluten-free diet (GFD) in Non-Coeliac Gluten/Wheat Sensitivity (NCGWS) is unclear. We present the largest study comparing adherence to a GFD in patients with Coeliac Disease (CD) and NCGWS and assess its impact on quality of life (QoL) and sleep in patients with NCGWS. Methods: Patients with NCGWS at a tertiary centre completed the Coeliac Disease Adherence Test (CDAT), Coeliac Symptom Index (CSI) and Sleep Condition Indicator (SCI). Higher CDAT scores indicate worse adherence, higher CSI scores indicate poorer QoL, and higher SCI scores indicate better sleep. CDAT scores were correlated with CSI and SCI scores. A second group of patients with CD completed the CDAT questionnaire only. Results were compared with the CDAT responses from the NCGWS group. Results: For the NCGWS cohort (n = 125), the median CDAT score was 17/35, indicating poor adherence. The median CSI score was 44/80, with 40% of scores associated with a poor QoL. The median SCI score was 14/32, and DSM-V criteria for insomnia was met by 42% of patients. There was a positive correlation between CSI and CDAT scores (r = 0.59, p < 0.0001) and a negative correlation between SCI and CDAT scores (r = −0.37, p = 0.0002). In the CD cohort (n = 170), the median CDAT score was 13/35. Patients with NCGWS had poorer adherence compared to CD (CDAT: 17.0 vs. 13.0, respectively, p = 0.0001). Conclusion: Patients with NCGWS adhere to a GFD less than those with CD. Poorer adherence to a GFD in patients with NCGWS correlates with a worse QoL and sleep performance.
Handover is a high-risk exercise. As the number of doctors in hospitals vary between shifts, continuity of care must be secured from many professionals down to a few. Literature has repeatedly shown that handover time is when the greatest number of medical errors occur [1]. Tasks may be inefficiently handover over, mis-represented or forgotten entirely. We have shared perspectives from a quality improvement (QI) project undertaken at the William Harvey Hospital, Kent, United Kingdom towards ensuring safe and smooth handover of medical tasks between shifts at the acute medical department in this hospital.
had had a dietetic review suggestive of good GFD adherence. RCD1 patients with ongoing VA (n=44) were invited to complete three gluten immunogenic peptides (GIP) tests, using rapid immunochromatographic testing, following the collection of mid-stream urine samples. Ongoing gluten ingestion was defined as having at least one weak positive/positive urine GIP sample. Results At diagnosis, RCD 1 patients were significantly younger than RCD2/CCD patients (p=0.002). 38 RCD1 patients with ongoing VA were recruited (71.1% female [n=27], median age 60 years). 52.6% (n=20) of patients with RCD1 had three negative GIP tests, suggestive of strict GFD adherence. However, 47.4% (n=18) had at least one positive GIP result, suggestive of possible ongoing gluten exposure.Conclusions A high proportion of individuals with RCD1 appear to have ongoing gluten exposure despite reported strict GFD adherence, as assessed by urine GIP. Urine GIP may redefine and enable the accurate diagnosis of RCD1 in the future.
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