Celiac Disease and Adherence to Gluten Free Diet; an Outpatient View

Document Type : Original Article


Clinical Nutrition Department, National Nutrition Institute (NNI), Cairo, Egypt


Celiac disease (CD) seems to be a considerable health disorder in Egypt. However, no full data on patients’ current situation concerning main presentation, tools commonly used for diagnosis, extent of adherence to gluten free diet (GFD), and long-term monitoring plan. This study was undertaken to investigate these important management issues. Design: A convenient sample of 72records was selected for those who were referred to the outpatient clinic of National Nutrition Institute (NNI) for prescribing a gluten-free diet for them and attended nutrition education sessions at NNI.Data was collected to evaluate patients’ current situation concerning main presenting manifestations, tools commonly used for diagnosis, and extent of adherence to gluten free diet. Results: 72.0% of cases were mainly in infancy and childhood age and number of referred girls/females was nearly double that of boys/males. Vomiting/diarrhea represented main manifestations (63.0%) and weight loss/failure to thrive was the next common (31.0%). Anemia was also common (25.0%). Anti-tissue transglutaminase IgA (anti-tTG) IgA (46.0%) and endoscopy (40.0%) were the main investigating tools.Duodenal biopsy was takenin 22.0% out of these 40.0% and villous lesion of various degrees was reported in only 22.0% out of these 40.0%. Quantitative assessment of Gluten Free Diet (GFD) adequacy showed multiple micronutrients’ insufficiency. Consumption of apparent and hidden gluten sources was dramatically decreased following the nutrition education and training sessions. The shortage in availability of gluten-free products and their high cost were among main obstacles. Conclusion and Recommendations: The only treatment for celiac disease, at present, is a strict gluten-free diet for life. There is an urgent need to increase awareness among primary health care physicians and pediatricians about the wide diversity of clinical manifestations and the role of serological testing in the diagnosis of celiac disease.Governmental support for providing GF products is mandatory for proper GF adherence and for improving nutrients’ adequacy.