Adherence to Gluten‐free Diet in a Celiac Pediatric Population Referred to the General Pediatrician After Remission

Abstract

Objectives: Assessment of adherence to gluten-free diet in celiac disease (CD) is generally recommended. Few data are available about consequences of transition from the referral center to the general pediatrician (GP) once remission is achieved. Methods: Adherence was assessed in patients referred to the GP for an annual basis follow-up, called back for re-evaluation. Immunoglobulin A (IgA) antitissue transglutaminase (anti-tTG) antibodies and the Biagi score (BS) were determined at last follow-up at the referral center (V1), and at re-evaluation (V2). Patients were classified as adherent (BS 3–4, IgA anti-tTG <7 U/mL) and nonadherent (BS 0–2, IgA anti-tTG ≥7). Scores of adherence were correlated with personal and clinical data. Results: We evaluated 200 patients. Overall, we found good adherence rates in 94.95% of patients at V1 and 83.5% at V2. IgA anti-tTG were negative in 100% at V1 and 96.97% at V2. BS is 3 to 4 in 94.5% at V1 and 84% at V2. Adherence at V2 was significantly worse than V1 (P < 0.001). No significant associations were found between scores of adherence and sex, symptoms and age at diagnosis, family history of CD, comorbidity, and diagnosis by endoscopy. Age 13 years or older represents a risk factor for lack of compliance at V1 (P = 0.02) and V2 (P = 0.04), and foreign nationality at V2 (P = 0.001). Conclusions: The BS, serology, and a clinical interview, integrated, are reliable tools for assessing pediatric adherence to gluten-free diet. We argue that referring patients to the GP after remission of CD is important, but the process must be improved and recommendations are required.

Australasian Pediatric Gastroenterologists’ Perspectives and Practices of Celiac Disease Diagnosis and Management

“…Adherence was assessed using the TGA IgA and Biagi Score [34]. The study found such practice is a reasonable approach to ongoing management of CeD [33]. However, in this study, age over 13 years and non-Italian ethnicity were both found to be associated with GFD non-adherence.…”

“…In a different approach, Sbravati et al [33] prospectively assessed the GFD adherence of 200 children over two intervals (at least 24 months) following transition from a single referral center to a general pediatrician once remission was achieved. Adherence was assessed using the TGA IgA and Biagi Score [34].…”

Challenges of Monitoring the Gluten-Free Diet Adherence in the Management and Follow-Up of Patients with Celiac Disease

“…The GFD adherence of 200 Italian children with CD was assessed to evaluate differences as a consequence of transition from a referral center (V1) to a general pediatrician (V2) [ 52 ]. Adherence was measured using the Biagi score and the IgA TGA test at the last follow-up at V1 and at an annual follow-up at V2.…”

New Insights into Non-Dietary Treatment in Celiac Disease: Emerging Therapeutic Options

“…Several studies based on nutritional questionnaires, serological tests, and evaluating gluten immunogenic peptides in feces and urine, have reported variable gluten exposure rates in patients with CD, reaching up to 69% in adults, 64% in adolescents, and 45% in children ( Figure 1 ) despite their best efforts to avoid it. Studies reporting gluten exposure rates may compromise high rates of ongoing symptoms [ 29 , 30 , 31 ] and enteropathy [ 32 , 33 , 34 , 35 ] in patients with CD, leading to comorbidities such as anemia, severe malabsorption, and various forms of malignancies [ 36 ]. Hence, it is important to drive efforts to develop non-dietary adjunctive or alternative therapies for CD treatment [ 37 ].…”

“… Studies reporting gluten exposure rates in CD patients on a supposed GFD. CD, celiac disease; GFD, gluten-free diet [ 23 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ]. …”