ABSTRACT
BACKGROUND: While adherence to gluten-free diet (GFD) is essential for effective control of celiac disease, the level of adherence to GFD may vary. We assessed the level of adherence to GFD and identified barriers to adherence in patients with celiac disease. METHODS: Both treatment-naive and follow up patients with celiac disease were recruited from a celiac disease clinic. All the patients were assessed for symptom improvement using celiac symptom index (CSI), weight, and hemoglobin; adherence to GFD using detailed dietary history and food-labeled quiz questionnaire; identification of barriers to GFD using a self-administered 36-point questionnaire; and quality of life using a standard 36-item short form (SF36) questionnaire. RESULTS: Among the patients who were already on GFD, only 53.3% maintained an excellent or good level of adherence, which increased to 92.4% at 6 months with repeated counseling. Among the treatment-naive patients, 64.8% maintained either excellent or good compliance at 1 month after first counseling, which increased to 96.3% at 6 months with repeated counseling. The most common barrier to adherence was non-availability of GFD. Certain barriers could be modified with repeated counseling and education. Response to GFD, as measured by CSI, gain in weight, and improvement in hemoglobin, was better in those having either excellent or good compliance to GFD compared to those who remained poorly adherent. CONCLUSIONS: Repeated counseling increased the level of adherence to GFD.
Subject(s)
Celiac Disease/diet therapy , Celiac Disease/psychology , Diet, Gluten-Free/statistics & numerical data , Patient Compliance/statistics & numerical data , Adolescent , Adult , Celiac Disease/physiopathology , Directive Counseling , Female , Humans , India/epidemiology , Male , Memory, Episodic , Patient Education as Topic , Surveys and Questionnaires , Tertiary Care Centers/statistics & numerical data , Time Factors , Young AdultABSTRACT
Celiac disease is emerging in India and has become a public health problem. Almost 6-8 million Indians are estimated to have celiac disease. While there is a large pool of patients with celiac disease in India, until now, only a fraction of them have been diagnosed. With increasing awareness about celiac disease amongst health care providers and the general population, a massive increase in the number of patients with celiac disease is expected now and in the subsequent decade in India. While the number of patients with celiac disease is increasing, the country's preparedness towards the emerging epidemic of this disease is minimal. There are a number of issues, which requires urgent attention. Some of the key issues include increased awareness amongst health care professionals and the general public about the disease and its management, team-based management of patients with celiac disease, proper counseling and supervision of patients, training of dietitians in the management of patients with celiac disease, industrial production of reliable and affordable gluten-free food, and food labeling for gluten contents.
Subject(s)
Celiac Disease/diet therapy , Celiac Disease/epidemiology , Diet, Gluten-Free , Feeding Behavior , Celiac Disease/complications , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/diet therapy , Glutens/adverse effects , Health Knowledge, Attitudes, Practice , Humans , India/epidemiology , Patient Compliance , PrevalenceABSTRACT
We report two cases, the first one a 35 years old male, chronic alcoholic, and the other, a 15 years old boy, who presented to us with fever, Rt. hypochondrial pain, with USG-Abdomen revealing multiple liver abscesses in the first, and a single large abscess in the second. Both patients showed leucocytosis and, mildly deranged Liver Function Tests. Aspirated pus was sterile, and the patients did not show any clinical improvement despite broad spectrum antibiotics and amoebicides. Re-aspiration of pus after two weeks revealed the presence of Mycobacterium tuberculosis and both patients showed a dramatic improvement clinically after starting Anti-tubercular treatment. These cases are being reported because of the rarity of tubercular liver abscesses, and the importance of suspecting mycobacterial infection in patients of liver abscess not responding to conventional treatment.
