Abstract | PURPOSE OF REVIEW: To describe whether a gluten-free diet (GFD) is indicated in Marsh I gluten-sensitive enteropathy where gastrointestinal symptoms are not present. Arguments are provided to prescribe a GFD to manage extraintestinal symptoms. By contrast, there are not enough reasons to prescribe a GFD to prevent long-term complications. RECENT FINDINGS: Population-based and prospective observational studies have found that lymphocytic duodenosis may be due to not just gluten-sensitive enteropathy but also due to other aetiologic factors. Marsh I type lesions may be the cause of iron-deficiency anaemia of unknown aetiology which is reverted by a GFD. A similar effect seems to occur with bone mineralization and hypertransaminasemia. The beneficial influence of a GFD reducing lymphoma and coeliac disease-related mortality remains controversial. SUMMARY: An appropriate differential diagnosis of the lymphocytic duodenosis is essential before a GFD is indicated. As a third of patients remained undiagnosed, in spite of genetic study and specific coeliac serology, flow cytometry and transglutaminase antibodies in duodenal tissue may be helpful in establishing gluten-sensitive enteropathy diagnosis. Future studies should assess whether lymphoma risk is reduced by a GFD in Marsh I patients. Also a more precise benefit in bone mineralization in this setting is needed.
|
Authors | Maria Esteve, Anna Carrasco, Fernando Fernandēz-Bañares |
Journal | Current opinion in clinical nutrition and metabolic care
(Curr Opin Clin Nutr Metab Care)
Vol. 15
Issue 5
Pg. 505-10
(Sep 2012)
ISSN: 1473-6519 [Electronic] England |
PMID | 22878244
(Publication Type: Journal Article, Review)
|
Chemical References |
- Antibodies
- HLA-DQ Antigens
- Transglutaminases
|
Topics |
- Anemia, Iron-Deficiency
(etiology)
- Antibodies
(metabolism)
- Bone Density
- Celiac Disease
(diet therapy, genetics, pathology)
- Diagnosis, Differential
- Diet, Gluten-Free
- Duodenal Diseases
(diet therapy, genetics, pathology)
- Duodenum
(immunology, pathology)
- Genotype
- HLA-DQ Antigens
(genetics)
- Humans
- Lymphocytes
(pathology)
- Lymphoma
(prevention & control)
- Transglutaminases
(immunology)
|