Prevalence and Etiologies of Non-Responsive Celiac Disease: A Systematic Review and Meta-Analysis
Document Type
Conference Proceeding
Publication Date
5-2024
Publication Title
Gastroenterology
Abstract
Introduction Lifelong gluten free diet (GFD) is the only known treatment of celiac disease (CeD), but the response is variable and a significant proportion of patients may continue to experience clinical symptoms despite adherence to GFD. Non-responsive CeD (NRCD) is defined as ongoing symptoms despite 6-12 months of GFD. There is inconsistency in studies describing the proportion of patients having NRCD and its various causes amongst patients with CeD. We therefore conducted a systematic review and meta-analysis to determine the prevalence and causes of NRCD. Methods We conducted a search of the PubMed, Embase, Cochrane Library, Scopus and Web of Science databases for original studies published in English reporting the proportion of patients with persistent symptoms after ≥6 months of GFD. Studies reporting the etiologies of NRCD were identified separately. The systematic review was conducted as per the metaanalysis of observational studies in epidemiology (MOOSE) guidelines. Quality assessment was performed using the Newcastle Ottawa Scale. Statistical analysis was performed in STATA v14. Results Of a total of 2,965 search results, after inclusion and exclusion criteria, 9 studies were included in the systematic review. Five studies (n=4,414) reported data on prevalence and 7 studies (n=790) reported the causes of NRCD. The pooled prevalence of NRCD was 22% (95%CI, 11-35%, I 2 = 98.6%, figure 1). Amongst patients with NRCD, inadvertent exposure to gluten was the most common cause (33% [95%CI, 27-39%, I 2 = 64.3%]), followed by functional gastrointestinal disorders including irritable bowel syndrome (16% [95%CI, 11-22%, I 2 = 76.7%]). Refractory CeD (RCD) type 2 along with its premalignant and malignant sequelae was noted in 7% (95%CI, 2-13%, I 2 = 88%) of patients with NRCD. Other causes of NRCD in this review were RCD type 1, small intestinal bacterial overgrowth, microscopic colitis, disaccharide intolerance, and inflammatory bowel disease. Discussion One in five patients with CeD may not respond to GFD and would likely be classified as NRCD. Amongst many other causes, commonest cause of NRCD was found to be inadvertent exposure to dietary gluten. In order to mitigate NRCD, patients with CeD should receive comprehensive counselling regarding GFD and a systematic approach should be followed for the appropriate evaluation for other causes of NRCD. Improving adherence to GFD along with developing novel therapeutics to mitigate symptoms due to ongoing gluten exposure is critical.
Volume
166
Issue
5 Suppl
First Page
S743
Recommended Citation
Aggarwal N, Bhatia U, Dwarakanathan V, Singh AD, Singh P, Ahuja V, et al. Prevalence and etiologies of non-responsive celiac disease: a systematic review and meta-analysis. Gastroenterology. 2024 May;166(5 Suppl):S743. doi:10.1016/S0016-5085(24)02188-7
DOI
10.1016/S0016-5085(24)02188-7
Comments
DDW Digestive Disease Week, May 18-21, 2024, Washington, DC