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Transition of Care in Celiac Disease

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Abstract

Celiac disease (CD) is a gluten related disorder which affects all age-groups and occurs in genetically susceptible population after introduction of gluten in diet. The worldwide prevalence of CD is ~1% and it is higher in certain “at-risk groups”. The clinical features are variable, ranging from classical diarrhea to an asymptomatic state. Diagnosis requires serology and duodenal histology although a non-biopsy diagnosis is recommended by European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) for a select group of children. Treatment of CD is with a life-long strict gluten free diet (GFD) along with correction of nutritional deficiencies. Regular follow-up to assess compliance and efficacy of GFD is mandatory. Non-responsive CD needs evaluation by a specialist as it can be due to incorrect diagnosis, poor dietary compliance, coexisting conditions like small bowel bacterial overgrowth, pancreatic insufficiency etc. and lastly, refractory CD. Most patients diagnosed as CD in childhood receive no medical or dietary supervision after transition to adulthood and nearly a third are non-compliant to GFD. No requirement of medications, patient’s perception of understanding GFD and absence of symptoms with intermittent non-compliance leads to neglect of care after transition. Poor dietary adherence leads to nutritional deficiencies, osteoporosis, fertility issues and risk of malignancy. It is mandatory that the patients know about CD, need of strict GFD, regular follow-up, disease complications, and are capable of communicating with the health-care personnel before transition. Formulating a phased transition care program with joint pediatric and adult clinics is required for a successful transition and improving the long-term outcome.

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References

  1. Fasano A, Catassi C. Clinical practice Celiac disease. N Engl J Med. 2012;367:2419–26.

    Article  CAS  PubMed  Google Scholar 

  2. Lindfors K, Ciacci C, Kurppa K, et al. Coeliac disease. Nat Rev Dis Primers. 2019;5:3.

    Article  PubMed  Google Scholar 

  3. King JA, Jeong J, Underwood FE, et al. Incidence of celiac disease is increasing over time: A systematic review and meta-analysis. Am J Gastroenterol. 2020;115:507–25.

    Article  PubMed  Google Scholar 

  4. Kreutz JM, Adriaanse MPM, van der Ploeg EMC, Vreugdenhil ACE. Nutrient deficiencies in adults and children with treated and untreated celiac disease. Nutrients. 2020;12:500.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Ludvigsson JF, Leffler DA, Bai JC, et al. The Oslo definitions for coeliac disease and related terms. Gut. 2013;62:43–52.

    Article  PubMed  Google Scholar 

  6. Rubio-Tapia A, Van Dyke CT, Lahr BD, et al. Predictors of family risk for celiac disease: A population based study. Clin Gastroenterol Hepatol. 2008;6:983–7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Husby S, Koletzko S, Korponay-Szabó I, Kurppa K, Mearin ML, Ribes-Koninckx C. European Society Paediatric Gastroenterology, Hepatology and Nutrition guidelines for diagnosing coeliac disease 2020. J Pediatr Gastroenterol Nutr. 2020;70:141–56.

    Article  PubMed  Google Scholar 

  8. Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: Time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol. 1999;11:1185–94.

    Article  CAS  PubMed  Google Scholar 

  9. Carroccio A, Di Prima L, Falci C, et al. Predictive value of serological tests in the diagnosis of celiac disease. Ann Ital Med Int. 2002;17:102–7.

    PubMed  Google Scholar 

  10. Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA. ACG clinical guidelines: Diagnosis and management of celiac disease. Am J Gastroenterol. 2013;108:656–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Al-Toma A, Volta U, Auricchio R, et al. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J. 2019;7:583–613.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Aljada B, Zohni A, El-Matary W. The gluten-free diet for celiac disease and beyond. Nutrients. 2021;13:3993.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Moreno ML, Cebolla Á, Muñoz-Suano A, et al. Detection of gluten immunogenic peptides in the urine of patients with coeliac disease reveals transgressions in the gluten-free diet and incomplete mucosal healing. Gut. 2017;66:250–7.

    Article  CAS  PubMed  Google Scholar 

  14. Syage JA, Kelly CP, Dickason MA, et al. Determination of gluten consumption in celiac disease patients on a gluten-free diet. Am J Clin Nutr. 2018;107:201–7.

    Article  PubMed  Google Scholar 

  15. Sansotta N, Amirikian K, Guandalini S, Jericho H. Celiac disease symptom resolution: effectiveness of the gluten-free diet. J Pediatr Gastroenterol Nutr. 2018;66:48–52.

    Article  PubMed  Google Scholar 

  16. Veeraraghavan G, Therrien A, Degroote M, et al. Non-responsive celiac disease in children on a gluten free diet. World J Gastroenterol. 2021;27:1311–20.

    Article  PubMed  PubMed Central  Google Scholar 

  17. O’Leary C, Wieneke P, Healy M, Cronin C, O’Regan P, Shanahan F. Celiac disease and the transition from childhood to adulthood: A 28-year follow-up. Am J Gastroenterol. 2004;99:2437–41.

    Article  PubMed  Google Scholar 

  18. Reilly NR, Hammer ML, Ludvigsson JF, Green PH. Frequency and predictors of successful transition of care for young adults with childhood celiac disease. J Pediatr Gastroenterol Nutr. 2020;70:190–4.

    Article  PubMed  Google Scholar 

  19. Mozer-Glassberg Y, Zevit N, Rosenbach Y, Hartman C, Morgenstern S, Shamir R. Follow-up of children with celiac disease – Lost in translation? Digestion. 2011;83:283–7.

    Article  PubMed  Google Scholar 

  20. Kori M, Goldstein S, Hofi L, Topf-Olivestone C. Adherence to gluten-free diet and follow-up of pediatric celiac disease patients, during childhood and after transition to adult care. Eur J Pediatr. 2021;180:1817–23.

    Article  CAS  PubMed  Google Scholar 

  21. Schiepatti A, Maimaris S, de Queiros C, et al. Long-term adherence to a gluten-free diet and quality of life of celiac patients after transition to an adult referral center. Dig Dis Sci. 2022;67:3955–63.

    Article  CAS  PubMed  Google Scholar 

  22. Zingone F, Massa S, Malamisura B, Pisano P. Ciacci C. Coeliac disease: Factors affecting the transition and a practical tool for the transition to adult healthcare. United European Gastroenterol J. 2018; 6:1356–62.

  23. Kivela L, Hekkala S, Huhtala H, Kaukinen K, Kurppa K. Lack of long-term follow-up after paediatric-adult transition in celiac disease is not associated with complications, ongoing symptoms or dietary adherence. United European Gastroenterol J. 2020;8:157–66.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ludvigsson JF. Transition from childhood to adulthood in coeliac disease: The Prague consensus report. Gut. 2016;65:1242–51.

    Article  PubMed  Google Scholar 

  25. Leffler DA, Dennis M, Hyett B, Kelly E, Schuppan D, Kelly CP. Etiologies and predictors of diagnosis in nonresponsive celiac disease. Clin Gastroenterol Hepatol. 2007;5:445–50.

    Article  PubMed  Google Scholar 

  26. Shah S, Akbari M, Vanga R, et al. Patient perception of treatment burden is high in celiac disease compared with other common conditions. Am J Gastroenterol. 2014;109:1304–11.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hall NJ, Rubin G, Charnock A. Systematic review: Adherence to a gluten-free diet in adult patients with coeliac disease. Aliment Pharmacol Ther. 2009;30:315–30.

    Article  CAS  PubMed  Google Scholar 

  28. Comino I, Fernández-Bañares F, Esteve M, et al. Fecal gluten peptides reveal limitations of serological tests and food questionnaires for monitoring gluten-free diet in celiac disease patients. Am J Gastroenterol 2016;111:1456–65.

  29. Mahadev S, Murray JA, Wu TT, et al. Factors associated with villus atrophy in symptomatic coeliac disease patients on a gluten-free diet. Aliment Pharmacol Ther. 2017;45:1084–93.

    Article  CAS  PubMed  Google Scholar 

  30. Ludvigsson JF. Mortality and malignancy in celiac disease. Gastrointest Endosc Clin N Am. 2012;22:705–22.

    Article  Google Scholar 

  31. Rubio-Tapia A, Murray JA. Classification and management of refractory celiac disease. Gut. 2010;59:547–57.

    Article  PubMed  Google Scholar 

  32. Askling J, Linet M, Gridley G, et al. Cancer incidence in a population-based cohort of individuals hospitalized with celiac disease or dermatitis herpetiformis. Gastroenterology. 2002;123:1428–35.

    Article  PubMed  Google Scholar 

  33. West J, Logan RF, Smith CJ, et al. Malignancy and mortality in people with coeliac disease: Population based cohort study. BMJ. 2004;329:716–9.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Elfstrom P, Granath F, Ekstrom Smedby K, et al. Risk of lymphoproliferative malignancy in relation to small intestinal histopathology among patients with celiac disease. J Natl Cancer Inst. 2011;103:436–44.

    Article  PubMed  Google Scholar 

  35. Murray JA, Rubio-Tapia A, Van Dyke CT, et al. Mucosal atrophy in celiac disease: Extent of involvement, correlation with clinical presentation, and response to treatment. Clin Gastroenterol Hepatol. 2008;6:186–93.

    Article  PubMed  Google Scholar 

  36. Kemppainen TA, Kosma VM, Janatuinen EK, Julkunen RJ, Pikkarainen PH, Uusitupa MI. Nutritional status of newly diagnosed celiac disease patients before and after the institution of a celiac disease diet–association with the grade of mucosal villous atrophy. Am J Clin Nutr. 1998;67:482–7.

    Article  CAS  PubMed  Google Scholar 

  37. Tersigni C, Castellani R, de Waure C, Fattorossi A, De Spirito M, Gasbarrini A. Celiac disease and reproductive disorders: Meta-analysis of epidemiologic associations and potential pathogenic mechanisms. Hum Reprod Update. 2014;20:582–93.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Sri Aurobindo Medical College and Postgraduate Institute, Indore, Madhya Pradesh, India

    Sumit K. Singh

  2. Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India

    Anshu Srivastava

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Both the authors contributed to literature search, drafting and review of this original manuscript. Both the authors are accountable for all aspects of the manuscript. AS will act as guarantor for this paper.

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Correspondence to Anshu Srivastava.

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Singh, S.K., Srivastava, A. Transition of Care in Celiac Disease. Indian J Pediatr 90, 1142–1148 (2023). https://doi.org/10.1007/s12098-023-04611-y

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