P-048 Prevalence of Gluten Free Diet and Symptom Improvement in Patients with Inflammatory Bowel Diseases in CCFA Partners Cohort

Abstract

BACKGROUND: Dietary interventions have been viewed as a possible therapeutic modality in adult inflammatory bowel diseases (IBD) patients, but so far clinical trials investigating diets have failed to yield significant benefit. Adherence to gluten free diet (GFD) without an underlying diagnosis of celiac disease has enjoyed rapid and widespread adoption in the US in recent years and currently at least 0.5% of the US population follow a GFD. A new disease entity designated as non-celiac gluten sensitivity has been associated with GI-symptoms such as bloating, diarrhea, abdominal pain, fatigue and nausea. Many of these symptoms can also be found in IBD patients. We therefore analyzed the prevalence and effects of a GFD in patients with IBD. METHODS: We analyzed disease characteristics and responses to a cross-sectional questionnaire in1647 IBD patients participating in CCFA Partners, a longitudinal, internet-based cohort. Questions included whether the individual carried a diagnosis of celiac disease or non-celiac gluten sensitivity, past or current practice of a GFD and the improvement of specific GI- symptoms or flares while on a GFD. For current users of a GFD we analyzed the degree of adherence to GFD using a validated GFD adherence questionnaire. Bivariate statistics were used to (Table presented) compare rates of GFD by disease characteristics and symptom improvement by GFD adherence. RESULTS: Ten (0.6%) and 81 (4.9%) patients had been diagnosed with celiac disease and gluten sensitivity, respectively. Three hundred fourteen (19.1%) participants reported ever having tried a GFD and 135 (8.2%) were currently adhering to it. No differences were found between the GFD and non-GFD groups in regard to disease type, duration of disease, educational status (Table 1). Fewer individuals who attempted a GFD were on 5-ASA (5-aminosalicylic acid) medications. A higher percentage of people not responding to (Table presented) GFD were on biologics (Table 2). Overall 206/314 (65.6%) of all patients trying a GFD reported an improvement in any GI-symptom. A total of 38.3% thought they experienced fewer and less severe flares and 23.6% reported requiring fewer medications to control the disease while being on a GFD. Improvements of the clinical symptoms bloating, diarrhea, abdominal pain, fatigue and nausea were reported by 56.5%, 42.6%, 41.5%, 27.5% and 23.6% on a GFD, respectively. Adherence to GFD was found to be excellent in 56/135 (41.5%), average in 46/135 (34.1%), and fair/poor in 33/135 (24.4%). Fatigue significantly improved with excellent adherence (P < 0.03), whereas no differences were found for the other clinical symptoms. CONCLUSIONS: A substantial number of patients with IBD in this cohort follow a GFD. The prevalence of celiac disease in this cohort is comparable to the US general population. More than half of these IBD patients on a GFD report symptom improvement, suggesting that a significant number of patients could suffer from non-celiac gluten sensitivity. Fewer responders to GFD were on biologic medications, demonstrating that flare symptoms in those with more severe disease may not respond to GFD. Future studies should evaluate if the reported therapeutic effects are specific for gluten exposure and/or the mechanism of this dietary approach.