PWE-117 Responses to dietary intervention guided by follow-up duodenal biopsy in coeliac disease

Abstract

comorbidities, haemoglobin levels, vitamin B 12 , folate, ferritin and albumin levels. A positive result was a rise in hydrogen of at least 20 ppm, or methane of 12 ppm, over the baseline for each gas. Results 447 patients were identified (120 male, median age 56 years, range 17e90). Overall 84/447 (18.8%) of tests were positive. The patient characteristics associated with a positive result were concurrent use of proton pump inhibitor (PPI) (p¼0.0005), previous partial gastrectomy (p<0.0001), previous right hemicolectomy (p¼0.0004), and age over 75 tears p<0.0001. The laboratory investigations predictive of a positive result were low vitamin B 12 (p¼0.02) and low albumin <30 g/dl (p¼0.03). Conclusion This is the largest single centre study of factors predictive of SIBO as defined by positive GHBT. Use of proton pump inhibitor, partial gastrectomy, right hemicolectomy, age over 75 years, low vitamin B 12 and low albumin were predictive of SIBO.

The management of refractory coeliac disease

“…2012]. In those with ongoing villous atrophy, similar proportions respond to more stringent dietary gluten exclusion with mucosal recovery [Sharkey et al 2012]. Anti-TTG antibody titres decline rapidly in the majority of coeliac patients excluding gluten effectively [Sugai et al 2010], however levels may be sustained for 1–2 years in a small proportion of patients.…”

“…Given that complete recovery is possible with gluten exclusion, it is likely that persisting minor grades of inflammation are due to low-level or intermittent gluten exposure. Intensive dietetic input for patients with persisting villous atrophy can result in normalization of the histological appearances [Sharkey et al 2012], however a small number of patients fail to respond. If these patients also experience symptoms and signs of malabsorption, then they would be considered to fulfil the definition of RCD.…”

“…In a study performed in Cambridge, approximately 25% of patients reverted to normal intestinal mucosa within a year, with a further 30% showing minor inflammation without villous atrophy [Corbett et al 2012]. In those with ongoing villous atrophy, similar proportions respond to more stringent dietary gluten exclusion with mucosal recovery [Sharkey et al 2012]. Anti-TTG antibody titres decline rapidly in the majority of coeliac patients excluding gluten effectively [Sugai et al 2010], however levels may be sustained for 1-2 years in a small proportion of patients.…”