Is a gluten-free diet necessary in Marsh I intestinal lesions in patients with HLADQ2, DQ8 genotype and without gastrointestinal symptoms?

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)