Coeliac disease during the teenage period: The value of serial serum folate estimations

Abstract

SUMMARY A group of teenage coeliac patients has been followed at three monthly intervals in the Outpatient Department to assess their progress and also to monitor their ability to maintain a gluten-free diet. After a follow-up period of four to six years a detailed reassessment was carried out in hospital on 10 patients, only five of whom had persevered with a gluten-free diet. The jejunal mucosal histology of those patients who did not persist with a gluten-free diet remained 'flat' although these patients appeared to have remitted clinically. Those subjects who did persist with a gluten-free regime had a normal or near normal mucosal histology. It was difficult on the basis of clinical, haematological, or biochemical criteria to separate the two groups. The best single assessment of whether these patients were maintaining a gluten-free diet was serial serum folate estimations. It is often extremely difficult to say whether teenage coeliac patients are keeping to their diet unless repeated jejunal biopsies are obtained, and this study suggests that serial serum folate estimations can act as a reasonable criterion of whether subjects are maintaining a gluten-free regime.It is now apparent that the sensitivity of the jejunal mucosa to gluten in coeliac patients is not confined to the paediatric period but is probably present throughout life (Sheldon and Tempany, 1966;Mortimer, Stewart, Norman, and Booth, 1968;Sheldon, 1969). Accordingly it is in the best interest of these patients that they should remain on a glutenfree diet both from the point of view of their general health and because the 'flat' intestinal mucosa which results from a gluten challenge in these subjects is a premalignant lesion (Gough, Read, and Naish, 1962;Harris, Cooke, Thompson, and Waterhouse, 1966;Austad, Comes, Gough, McCarthy, and Read, 1967;Brunt, Sircus, and MacLean, 1969). It is probable that withdrawing gluten from the diet on a permanent basis will protect them from the tendency to malignant change (Harris, Cooke, Thompson, and Waterhouse, 1967

Compliance With Gluten‐free Diet in Children With Coeliac Disease

“…Although positive in all of our patients that had completely abandoned the diet, the test was negative in almost two thirds of patients on the partial diet. However, jejunal atrophy has been reported in almost all of the patients who take gluten, either permanently or occasionally (17,19,20,22,25). Other authors found morphometric changes of jejunal mucosa in half of children who were occasionally taking small quantities of gluten (17).…”

“…However, literature reports are not consistent regarding the effect of gluten intake on growth and development. Despite having mucosal atrophy, the majority of patients on a glutencontaining diet have no symptoms (2,(17)(18)(19)(20)24,25). Laboratory tests seem not to be sensitive enough to detect the occasional gluten intake (10,18,22,(25)(26)(27)(28).…”

“…Despite having mucosal atrophy, the majority of patients on a glutencontaining diet have no symptoms (2,(17)(18)(19)(20)24,25). Laboratory tests seem not to be sensitive enough to detect the occasional gluten intake (10,18,22,(25)(26)(27)(28). However, 50% of children who take small amounts of gluten show morphometric changes of intestinal mucosa and probably expose themselves to the risk for complications (20,26).…”

The teenage coeliac: follow up study of 102 patients.

“…'1 On the basis of clinical and laboratory findings, these groups came to the conclusion that a strict gluten free diet should be recommended for life. Compliance with this strict diet is, however, very variable.4 5 The aim of this study was twofold. Firstly, we wished to assess the general wellbeing of teenage patients with coeliac disease and to correlate this with the strictness of their gluten free diet.…”

Coeliac disease: part 1

“…It is not surprising, in light of the above, that Hcy levels are also elevated in untreated CD, and that all this tends to normalise when patients go onto a GFD 7,8,12 . New Study 3 shows that this can be accelerated by giving these vitamins as supplements, something that another recent Dutch trial also reported, (along with the fact that B 6 and folate but not B 12 levels were significantly correlated with serum Hcy) 21 .…”