Gluten-free diet adherence with coeliac disease.
Medical Student Bursary Winner
“Assessment of Gluten-Free Diet adherence in adults with coeliac disease”
The main treatment for coeliac disease is a lifelong gluten free diet which allows healing of the small bowel (reversal of VA) ultimately reducing the risk of complications such as gastrointestinal malignancies. Despite these benefits, rates of adherence for a gluten free diet range between 42% and 91%. The only accurate method of confirming resolution of VA is by taking a duodenal biopsy, and therefore biopsies may be viewed as the optimal method of assessing GFD adherence. However, many non-invasive markers of adherence are used in clinical practice, including dietitian evaluation, serological markers, and patient questionnaires.
‘The two aims of my study were to investigate the value of taking an additional biopsy from the duodenal bulb (the first part of the small bowel), and the performance of the Coeliac Dietary Adherence Test (CDAT) questionnaire, when assessing gluten free diet adherence in adults with Coeliac disease.
I found that an additional biopsy from the duodenal bulb increased the detection of persisting VA by 10.4%. The CDAT performed poorly when predicting persisting VA, with a sensitivity of 55.6% and specificity of 52.5%.
This was the largest study to date to assess the use of a duodenal bulb biopsy in patients with established Coeliac disease, and was the first study to investigate the performance of the CDAT. We concluded that the gold standard for predicting persisting VA should be a repeat biopsy with the inclusion of a bulb biopsy. This data has the potential to alter guidelines outlining follow-up of CD patients in the future.’
Why did you choose this project?
‘Throughout medical school I have come to appreciate the burden of treatment adherence experienced by patients with chronic health conditions, such as coeliac disease (CD) and the importance of optimal monitoring and follow-up in order to best support these patients. This, coupled with my interest in Gastroenterology, was the reason I chose this project for my intercalated BMedSci.”
“I am absolutely delighted to have been awarded one of the Dr Falk/Guts UK Medical Student prizes. This award is of great value to me personally as testimony to the work I have put in over my intercalated year.
This award will help fund my attendance at international conferences to further my knowledge and also support applications to job posts in the future.”Sarah Coleman