"The crackers challenge": A reassuring low-dose gluten challenge in adults on gluten-free diet without proper diagnosis of coeliac disease.

Autor: Rispo A; Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Italy. Electronic address: antonio.rispo2@unina.it., Guarino AD; Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Italy., Siniscalchi M; Department of Medicine, Surgery, and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Italy; Gastroenterology Unit, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy., Imperatore N; Gastroenterology and Endoscopy Unit, P.O. Santa Maria Delle Grazie, Pozzuoli, Naples, Italy., Santonicola A; Department of Medicine, Surgery, and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Italy; Gastroenterology Unit, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy., Ricciolino S; Gastroenterology and Endoscopy Unit, P.O. Santa Maria Delle Grazie, Pozzuoli, Naples, Italy., de Sire R; Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Italy., Toro B; Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Italy., Cantisani NM; Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Italy., Ciacci C; Department of Medicine, Surgery, and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Italy; Gastroenterology Unit, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
Jazyk: angličtina
Zdroj: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver [Dig Liver Dis] 2024 Sep; Vol. 56 (9), pp. 1517-1521. Date of Electronic Publication: 2024 Mar 23.
DOI: 10.1016/j.dld.2024.03.004
Abstrakt: Background: Gluten-free diet (GFD) is the one therapy in coeliac disease (CeD). Unfortunately, some patients adopt GFD before the diagnostic work-up. The guidelines suggest a 14-day gluten intake > 3 gr to get CeD diagnosis, although many subjects refuse this approach. Other evidence showed that the intake of 50 mg/day of gluten for 3 months could be useful for CeD diagnosis.
Aims: We performed a dietary study, administering a low dose of gluten in form of "crackers" (about 60-120 mg of gluten/day) for 3 months, to get a final diagnosis of CeD in subjects already on GFD.
Methods: We enrolled adult patients with a suspicion of CeD on self-prescribed GFD. All subjects performed the crackers challenge for 3 months. At the end, all patients were analysed for CeD serology and if positive underwent endoscopy/histology. Also, we recorded the grade of satisfaction for the gluten challenge and the onset of adverse events.
Results: We enrolled 120 patients. All patients concluded the challenge without relevant adverse events. Serological positivity was detected in 54 patients (45%). Histology showed atrophy in 87% and Marsh 1-2 grade in 13% of patients. Ninety-nine patients (83%) were satisfied by this challenge.
Conclusions: The "crackers challenge" is a useful and safe diagnostic approach in people on self-administered GFD.
Competing Interests: Conflict of interest None.
(Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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