Reconsiderations on the value of the celiac diet in patients without intestinal biopsy

ABSTRACT

To evaluate the effectiveness of a gluten free diet in symptomatic patients who are thought to have celiac disease but who have not undergone a definitive biopsy and to evaluate the accuracy of other diagnostic methods. This was a prospective study that included all patients with symptoms of celiac disease who were seen in a central pediatric gastroenterology clinic in Damascus over a three year period [from September 2002 to September 2005]. A gluten free diet had been applied for at least three months and then stopped. At that time, anti endomysial antibodies were measured and growth curves analyzed. There were 44 subjects on gluten free diet, ranging in age from six months to 11 years. At the beginning of the study, the d-xylose test was positive in 54%; no test was done in 25%; and 21% were included on the basis of stool analysis [10%], anti endomysial antibody [3%], or intestinal x-rays [8%]. The duration of gluten free diet was three months to four years. Over a third of the patients [37.5%] were on a gluten free diet for more than one year. Diagnostic procedures [anti endomysial antibody and growth curves] were repeated. After the gluten free diet ended, anti endomysial antibodies became positive in two cases. The growth curve changed in one other case. In all three of these cases, the intestinal biopsies were compatible with celiac disease according to the Marsh classification. Thus celiac disease was present in only 6.81% of the children undergoing treatment. The results suggest that a gluten free diet should not be applied without the confirmation of a small intestinal biopsy. A small percentage of children with symptoms of celiac disease were confirmed to have this diagnosis