A dietitian‐led coeliac service helps to identify and reduce involuntary gluten ingestion with subsequent reduction in the frequency of repeat endoscopies

Abstract

BackgroundDietitian‐led coeliac clinics have the potential to be a cost‐effective way of monitoring patients living with coeliac disease (CD). The aim of this service evaluation was to explore the impact of a dietitian‐led coeliac clinic on gluten‐free diet (GFD) adherence and the frequency of endoscopies with repeat duodenal biopsies.MethodsAdults with biopsy‐proven CD were transferred to a new dietitian‐led coeliac clinic where data were collected from medical records and analysed using SPSS. GFD adherence was assessed by a specialist dietitian, specialist nurse, consultant gastroenterologists and a validated GFD adherence questionnaire. Repeat duodenal biopsy findings were compared with the most recent dietitian GFD adherence assessment. Project and ethics approval was granted by the hospital trust and affiliated university.ResultsData from 170 patients (White: 51%, South Asian: 45%) are presented, with most being 35–64 years old (61%). Specialist dietitian assessments identified 67 (39%) of patients were adhering to the GFD, whereas prior gastroenterologist or coeliac nurse assessments identified 122 (72%) (p < 0.001) and the validated GFD adherence questionnaire identified 97 (57%) (p < 0.001). Dietitian assessments identified involuntary gluten consumption in 39/104 (38%) of those who self‐reported GFD adherence, consequently avoiding the need for nine endoscopies with repeat duodenal biopsies once patients had received dietary education from the dietitian. On follow‐up, within the dietitian‐led coeliac clinic, significantly fewer patients consumed gluten involuntarily (14%, p < 0.001). In addition, a reduction in voluntary gluten consumption was observed from three to five to one to two times per month (p < 0.001) in 66 patients.ConclusionsThe dietitian‐led coeliac clinic helped to identify involuntary gluten ingestion, avoid repeat endoscopies with duodenal biopsies and was associated with significantly improved GFD adherence.

The Gluten-Free Diet for Celiac Disease: Critical Insights to Better Understand Clinical Outcomes

“…In the UK, the dietitian’s role in supporting patients living with CeD has been explored using dietitian-led celiac clinics, where specialist dietitians become the leading healthcare provider supporting patients living with CeD, with support from a gastroenterologist when needed. A recent UK service evaluation [ 198 ] of a newly implemented dietitian-led celiac service found that it was associated with a significant reduction in both voluntary and involuntary gluten ingestion after all 170 patients had received dietary education from a specialist CeD dietitian. GFD adherence improvements happened despite patients being previously followed-up by a gastroenterologist or celiac nurse in the same hospital.…”