A dietitian-led coeliac service helps to identify and reduce involuntary gluten ingestion with subsequent reduction in the frequency of repeat endoscopies

Cristian Costas-Batlle; Nick Trott; Yvonne Jeanes; Leah Seamark; Claire Gardiner

doi:10.1111/jhn.13206

A dietitian-led coeliac service helps to identify and reduce involuntary gluten ingestion with subsequent reduction in the frequency of repeat endoscopies

J Hum Nutr Diet. 2023 Oct;36(5):1751-1759. doi: 10.1111/jhn.13206. Epub 2023 Jul 27.

Authors

Cristian Costas-Batlle¹, Nick Trott², Yvonne Jeanes³, Leah Seamark⁴, Claire Gardiner⁵

Affiliations

¹ Dietetic Department, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
² Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK.
³ School of Health and Life Sciences, University of Roehampton, London, UK.
⁴ Community Dietetics, Somerset NHS Foundation Trust, Somerset, UK.
⁵ School of Health, Leeds Beckett University, Leeds, UK.

PMID: 37497810
DOI: 10.1111/jhn.13206

Abstract

Background: Dietitian-led coeliac clinics have the potential to be a cost-effective way of monitoring patients living with coeliac disease (CD). The aim of this service evaluation was to explore the impact of a dietitian-led coeliac clinic on gluten-free diet (GFD) adherence and the frequency of endoscopies with repeat duodenal biopsies.

Methods: Adults with biopsy-proven CD were transferred to a new dietitian-led coeliac clinic where data were collected from medical records and analysed using SPSS. GFD adherence was assessed by a specialist dietitian, specialist nurse, consultant gastroenterologists and a validated GFD adherence questionnaire. Repeat duodenal biopsy findings were compared with the most recent dietitian GFD adherence assessment. Project and ethics approval was granted by the hospital trust and affiliated university.

Results: Data from 170 patients (White: 51%, South Asian: 45%) are presented, with most being 35-64 years old (61%). Specialist dietitian assessments identified 67 (39%) of patients were adhering to the GFD, whereas prior gastroenterologist or coeliac nurse assessments identified 122 (72%) (p < 0.001) and the validated GFD adherence questionnaire identified 97 (57%) (p < 0.001). Dietitian assessments identified involuntary gluten consumption in 39/104 (38%) of those who self-reported GFD adherence, consequently avoiding the need for nine endoscopies with repeat duodenal biopsies once patients had received dietary education from the dietitian. On follow-up, within the dietitian-led coeliac clinic, significantly fewer patients consumed gluten involuntarily (14%, p < 0.001). In addition, a reduction in voluntary gluten consumption was observed from three to five to one to two times per month (p < 0.001) in 66 patients.

Conclusions: The dietitian-led coeliac clinic helped to identify involuntary gluten ingestion, avoid repeat endoscopies with duodenal biopsies and was associated with significantly improved GFD adherence.

Keywords: adherence; celiac disease; coeliac disease; dietitian; endoscopy; gluten-free diet.

MeSH terms

Adult
Celiac Disease*
Diet, Gluten-Free
Eating
Glutens
Humans
Middle Aged
Nutritionists*
Patient Compliance

Substances

Glutens