Introduction: The celiac disease (CD) is characterized by a permanent sensitivity to gluten. The treatment for this disease is the life-long strict compliance with a gluten-free diet (GFD). The average of compliance with GFD ranges between 15% and 80%. Antibodies' role in the follow up of these patients regarding the adherence to the GFD is not well established. Objective. To determine the relationship between the antibodies for CD and the adherence to the GFD in patients with over a year of treatment.
Material and methods: Patients with CD with a minimum of one year of GFD were prospectively included They were asked to complete a self-survey regarding to the compliance to GFD and the level of adherence was determined: low (no compliance or more than 2 gluten intakes per week), medium (1 or 2 gluten intakes per week or 2 or 3 gluten intakes per month), or high (1 gluten intake per month or less than 3 intakes per year). The follow up was performed by their general practitioners. From one year of GFD onwards, the results of the available antibodies at the time of the last follow up were assessed: antigliadine IgA (AGA) and IgG (AGG), anti-endomysium IgA (EMA) and IgG (EMG), anti-transglutaminase (ATG), and deaminated peptides of gliadine IgA and IgG, considering them as positive or negative. Through an univariate analysis, the above-mentioned antibodies were correlated (independent variables) in order to identify predicting factors of high and low adherence to the GFD (dependent variables).
Results: Ninety patients were analyzed, age 43.6 +/- 15.3 years old, 89% women, 58% classic celiacs. The average time of GFD was 7.9 years and 63% had been on a GFD for over 3 years. A 71% of patients (95% CI 69%-80%) showed high adherence to the GFD, and a 67% (95% CI 2%-13%) showed low adherence. GFD of less than 3 years was a determining factor for low adherence [relative risk (RR) 2.41 (95% CI 1.2-2.89)]. The predictive antibodies for GFD high adherence were: (1) negative EMA [RR 1.27 (95% CI 1.03-1.54)], (2) negative ATG [RR 1.62 (95% CI 1.12-2.47)], and (3) all negative requested ones [RR 1.60 (95% CI 1.17-2.18)]. The predictive antibodies for GFD low adherence were: (1) positive AGA [RR 15.5 (95% CI 2.29-105)], (2) positive EMA [RR 10.2 (95% CI 2.19-47.7)], (3) positive ATG [RR 9.63 (95% CI 1.53-63.4)], and 4) all negative requested ones [RR 0.11 (95% CI 0.018-0.71)].
Conclusion: After one year of treatment, the negativity of EMA or ATG antibodies had a significant correlation with the high adherence to GFD and the positivity of AGA, EMA or ATG antibodies had a significant correlation with a low adherence.