Coeliac Disease – pitfalls in monitoring adherence to a gluten free diet
I want you to consider that everything we’re doing is wrong. This was the opening statement made by a Professor of Gastroenterology presenting at a UK symposium last year. The topic of discussion was how we monitor coeliac disease. With adherence rates reported to be between 42 and 92%, it is true that many coeliacs are at risk of developing complications. These are such as lymphoma, ulcerative jejunitis, osteoporosis, infertility, and nutritional deficiencies. In children signs of non-adherence include faltering growth and delayed puberty. To reduce the incidence of comorbidity we must have the right tools to detect gluten exposure. There are a variety of methods used in practice to assess adherence to a gluten free diet – validated scores, questionnaires, ask the patient, request a dietitian review and of course serology. Healthcare professionals like numbers, and biomarkers give us quick reassurance; until they don’t.
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