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CLINICAL FEATURES AND SYMPTOM RECOVERY ON A GLUTEN-FREE DIET IN A CANADIAN CELIAC POPULATION
M Zarkadas1, O Pulido2, S Dubois2, I Cantin2, K Collins1, S Godefroy2, M Prince1, C Switzer3, M Rashid4 1Canadian Celiac Association, Mississauga; 2Health Canada, Ottawa, Ontario; 3Univesity of Alberta, Edmonton, Alberta; 4Dalhousie University, Halifax, Nova Scotia
AIMS: Celiac disease (CD) is a common disorder affecting 1% of the population. Symptoms of CD are highly variable and delays in diagnosis are common. Lifelong adherence to a strict gluten-free diet (GFD) is the only treatment which improves symptoms and reduces the risk of complications including osteoporosis, infertility and cancer in patients with CD. Following a strict GFD can be challenging since gluten is ubiquitous in western foods and is difficult to avoid in many daily life situations.
To investigate, as part of a larger study entitled "Living with a Gluten-Free Diet", the clinical features including symptoms and their recovery and compliance with gluten-free diet in Canadian adults with celiac disease.
METHODS: All members >=18 years of age of Canada's two celiac support organizations: the Canadian Celiac Association, (n=7,872 English) and the Fondation quebecoise de la maladie coeliaque, (n=2,821 French) were surveyed in December 2008 with a mailed questionnaire.
RESULTS: The response rate to the mailed questionnaires was 72%. These preliminary data are reported on the subset of 5,751 respondents >=18 years of age with biopsy-diagnosed CD. Mean age was 56.4±15.2 years, range 18 to 93 years, 74.6% were females. Mean age at diagnosis of CD was 45.6±16.3 years, range 1 to 90 years with over 78% of the respondents being diagnosed between 30 and 69 years of age. The median duration of symptoms before diagnosis was 6 years (mean 12 years).
Common symptoms before starting GFD in descending order included abdominal pain/bloating, fatigue, diarrhea, anemia, weight loss, feeling depressed, bone/joint pain, constipation, mouth ulcers and migraine, which ranged from approximately 85% down to 28%. Recoveries from the symptoms while on a GFD ranged from recovery approximately 90% of respondents with weight loss to 35% recovery from bone and joint pain.
Consumption of a strict GFD all the time was reported by approximately 82% of respondents. Adverse reactions to ingesting gluten (either purposely or inadvertently) were reported by 79.9%. Reactions included abdominal pain, bloating/gas, diarrhea and vomiting. The median time to reaction was 2 hours (mean 7.4 hrs), with the reaction lasting a median of 24 hours (mean 47 hrs). Pure uncontaminated oats had been tried by 43.2%, of which 80.9% reported no adverse effects.
CONCLUSIONS: Delays in diagnosis of CD remain common. Reasons for continued symptoms include possible gluten consumption. Awareness of clinical features and treatment of CD need to be improved and careful dietary instruction is essential for patients to enable recovery from symptoms and reduce their risk of potential complications.