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e154
Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
information on GFD received at the time of diagnosis and disease
duration.
Conclusions:
In our reality celiac patients seem to be well informed
about GFD. Frequently they unnecessarily avoid foods that are safe
because gluten free. We identified some categories of celiac patients
at risk of less knowledge of GFD who deserve special training and
attention.
P.06.3
FODMAPS FREE DIET: AN EFFECTIVE SOLUTION FOR
SYMPTOMATIC COELIAC PATIENTS ON GLUTEN FREE DIET
Imperatore N.*
1
, Rispo A.
1
, Capone P.
1
, Castiglione F.
1
, Gerbino N.
1
,
Lucci L.
2
, Accarino G.
2
, Caporaso N.
1
, Tortora R.
1
1
Gastroenterology “Federico II” University, Naples, Italy,
2
Nutrition
“Federico II” University, Naples, Italy
Background and aim:
Recent studies have shown high efficacy of
a FODMAPs free diet (FFD) in patients suffering from non-coeliac
wheat sensitive (NCWS) and irritable bowel syndrome (IBS), but
data on this kind of dietary approach in coeliac disease (CD) are
still scarce.
Aim:
to establish the efficacy of FFD in symptomatic CD
patients despite being on gluten free diet (GFD), also comparing this
outcome with that of subjects affected by IBS.
Material and methods:
From January 2016 to September 2016
we carried out an observational prospective study including all
consecutive adult CD patients (Group A) who were symptomatic
(abdominal pain, diarrhoea, bloating, constipation) despite
performing a strict GFD. Also, we enrolled all consecutive adult
IBS patients (Group B) referred to our general Ambulatory. We
administered a personalized FFD and 2 questionnaires (IBS-SSS with
a pain score from 0-minimum to 3-maximum, and SF-36 with 8
different domains) at the time of the first visit (T0), 1month after (T1)
and at 3 months (T3) from the beginning of FFD. Statistical analysis
included ANOVA test with and without covariates adjustment. All
results were considered significant with a p< 0.05.
Results:
Finally, 66 patients were enrolled (Group A: 23 vs Group B:
43). All CD patients were on GFD from at least 1 year and showed
negative EMA and anti-transglutamineases. No differences were
noted in terms of age and gender (P = NS). When analyzing the
IBS-SSS results, the symptomatic score dropped in both Groups
after starting FFD (Group A: 2.04 at T0, 1.26 at T1 and 1.09 at T3
(P < 0.01); Group B: 2.35 at T0, 1.42 at T1 and 1.07 at T3 (P < 0.01)).
However, no statistically significant differences were noted between
the two Groups (P = NS). When analyzing the results from SF-36, no
differences were noted between the two Groups, even though both
CD and IBS population significantly improved their own status with
the regards of the 8 domains of SF-36, both at T1 (P < 0.01) and at
T3 (P < 0.01).
Conclusions:
FFD leads to a significant improvement of
gastrointestinal symptoms in CD patients who were persistently
symptomatic despite GFD. GFD in association with FFD should be
considered a first-line therapy CD this population.
P.06.4
ADULT CELIAC PATIENTS ADHERENCE TO A FOLLOW-UP
PROGRAM IN THE FIRST YEAR OF GLUTEN-FREE DIET: A SINGLE
CENTER STUDY
Sacchi M.C., Galli G.*, Esposito G., Carabotti M., Lahner E.,
Annibale B.
University Sapienza, Roma, Italy
Background and aim:
Coeliac disease (CD) is an immune-mediated
enteropathy. The treatment for CD is a gluten-free diet (GFD), which
requires significant patient education, motivation and follow-up.
Usually celiac patients are not included in a standardized follow-up
neither for the first year, nor for the subsequent years. Aim of this
study was to assess the patients adherence to time-based protocol
in the first year of GFD and if clinical characteristics and histological
parameters could affect the adherence to follow-up.
Material and methods:
226 consecutive newly diagnosed out
patients with biopsy-proven atrophic CD, diagnosed between 2002
and 2014 (median age 33yrs, 16-72; 79% female), were included.
Clinical data were collected using a structured clinical questionnaire,
including life style items, gastrointestinal symptoms, biochemical
values and histological score. Moreover each patient was instructed,
by a specific sheet, to follow a follow-up program that included
five items: after 3 months of GFD: 1) outpatient visit; after 1 year
of GFD: 2) serologic testing for specific antibody assay and 3)
nutritional parameters, 4) endoscopy with biopsy and 5) outpatient
visit including a validated questionnaire for GFD adherence. Full
adherence to the program was defined when patients underwent to
all five controls. Adherence >50% and <50% were defined when the
patients underwent at least three or four controls of five and at least
one or two of five, respectively. Statistical analysis was performed
using the Cochran-Armitage for trend in order to compare groups
with different adherence to the follow-up program.
Results:
41.9% of patients had full adherence to the program, while
23.6% did not undergo any control. A first degree familiarity for CD
positively affected the adherence to follow-up (p=0.04), and the
presence of symptoms at diagnosis affected it negatively (p=0.04).
Among patients with full adherence to the follow-up protocol 87,5%
had adequate compliance to GFD, while only 40% of patients with
<50% adherence to follow-up showed an adequate compliance to
diet (p=0.0001).
Conclusions:
This study showed that full adhesion to the follow-
up program in the first year of GFD in adult patients occurred in
only 41.9% of patients influencing positively the adherence to GFD. A
scheduled follow-up program should be proposed in the adult celiac
patients management.
P.06.5
HIGH SMAD7 IN REFRACTORY CELIAC DISEASE SUSTAINS
INFLAMMATORY CYTOKINE RESPONSE
Sedda S.*
1
, De Simone V.
1
, Marafini I.
1
, Paoluzi O.A.
1
, Colantoni A.
1
,
Ortenzi A.
1
, Giuffrida P.
2
, Di Sabatino A.
2
, Pallone F.
1
, Monteleone G.
1
1
University Tor Vergata, Rome, Italy,
2
University Of Pavia, Pavia, Italy
Background and aim:
Background. Refractory celiac disease (RCD)
is a severe form of celiac disease (CD) resistant to gluten-free diet
and associated with elevated risk of complications. Enhanced
production of inflammatory cytokines is supposed to contribute to
the RCD-associated lesions, even though it remains unclear if tissue
destructive inflammatory response is also sustained by defects in
counter-regulatory mechanisms. One such a mechanism could
involve transforming growth factor (TGF)
b
1, an immunesuppressive
cytokine that negatively regulates inflammatory responses in the
gut.
Aim. To determine whether RCD-related inflammation is marked by
elevated levels of Smad7, an intracellular inhibitor of TGF-
b
1 activity.
Material and methods:
Methods. Smad7 expression was evaluated
in duodenal biopsy samples of patients with RCD, patients with
active CD (ACD), patients with inactive CD (ICD), and normal
controls by western blotting, immunohistochemistry and RT-PCR. In
biopsy samples taken from the same groups of patients and controls,
TGF
b
1 and phosphorylated Smad2/3 were evaluated by ELISA and
immunohistochemistry respectively. Expression of proinflammatory
cytokines was assessed in RCD biopsy samples cultured with Smad7
sense or antisense oligonucleotide by RT-PCR.