CD: Assessment of Gastrointestinal Symptoms 2009
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
CD: Assess Gastrointestinal Symptoms
The registered dietitian (RD) should assess gastrointestinal symptoms (such as type, frequency and volume of bowel function; abdominal pain and bloating; nausea or vomiting; reduced gut motility and delayed gastric emptying) in individuals with celiac disease. Several studies have reported that people with celiac disease (treated and untreated) are more likely to experience gastrointestinal symptoms than are healthy control subjects.
Risks/Harms of Implementing This Recommendation
Conditions of Application
Potential Costs Associated with Application
Although costs of medical nutrition therapy (MNT) sessions and reimbursement vary, MNT sessions are essential for improved outcomes.
- Several studies have reported that people with celiac disease (treated and untreated) are more likely to experience gastrointestinal symptoms such as diarrhea, constipation, abdominal pain and bloating, nausea or vomiting, reduced gut motility and delayed gastric emptying than are healthy control subjects (Cucchiara et al, 1995; Usai et al, 1995; Chiarioni et al, 1997; Fine et al, 1997; Benini et al, 2001; Cuomo et al, 2003; Midhagen et al, 2003; Tursi et al, 2003; Murray et al, 2004; Hopper et al, 2005; Viljamaa et al, 2005; Casellas et al, 2006)
- Compliance with a gluten-free diet reduces the prevalence of these symptoms
- Further evaluation of persistent gastrointestinal symptoms in some individuals with celiac disease is recommended. Evidence is limited regarding the effect of a gluten-free dietary pattern on indigestion, dysphagia and reflux; additional research is needed in these areas.
Recommendation Strength Rationale
Conclusion statement received Grade II.
- Risks/Harms of Implementing This Recommendation
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
Benini L, Sembenini C, Salandini L, Dall'O E, Bonfante F, Vantini I. Gastric emptying of realistic meals with and without gluten in patients with celiac disease. Effect of jejunal mucosal recovery. Scand J Gastroenterol 2001;36(10):1044-1048.
Casellas F, Lopez Vivancos J, Malagelada JR. Current epidemiology and accessibility to diet compliance in adult celiac disease. Rev Esp Enferm Dig 2006;98(6):408-419.
Chiarioni G, Bassotti G, Germani U, Battaglia E, Brentegani MT, Morelli A, Vantini I. Gluten-free diet normalizes mouth-to-cecum transit of a caloric meal in adult patients with celiac disease. Dig Dis Sci 1997;42(10):2100-2105.
Cucchiara S, Bassotti G, Castellucci G, Minella R, Betti C, Fusaro C, Morelli A, Bertotto A, Auricchio S. Upper gastrointestinal motor abnormalities in children with active celiac disease. J Pediatr Gastroenterol Nutr 1995;21(4):435-442.
Cuomo A, Romano M, Rocco A, Budillon G, Del Vecchio Blanco C, Nardone G. Reflux esophagitis in adult celiac disease: beneficial effect of gluten-free diet. Gut 2003;52:514-517.
Fine KD, Meyer RL, Lee EL. The prevalence and causes of chronic diarrhea in patients with celiac sprue treated with a gluten-free diet. Gastroenterology 1997;112(6):1830-1838.
Hopper AD, Leeds JS, Hurlstone DP, Hadjivassiliou M, Drew K, Sanders DS. Are lower gastrointestinal investigations necessary in patients with celiac disease? Eur J Gastroenterol Hepatol 2005;17(6):617-21.
Midhagen G, Hallert C. High rate of gastrointestinal symptoms in celiac patients living on a gluten-free diet: controlled study. Am J Gastroenterol 2003;98(9):2023-2026.
Murray JA, Watson T, Clearman B, Mitros F. Effect of a gluten-free diet on gastrointestinal symptoms in celiac disease. Am J Clin Nutr 2004; 79: 669-673.
Tursi A, Brandimarte G, Giorgetti G. High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal. Am J Gastroenterol 2003;98(4):839-843.
Usai P, Bassotti G, Usai Satta P, Cherchi MV, Plesa A, Boy F, Morelli A, Balestrieri A. Oesophageal motility in adult celiac disease. Neurogastroenterol Motil 1995;7(4):239-244.
Viljamaa M, Collin P, Huhtala H, Sievanen H, Maki M, Kaukinen K. Is coeliac disease screening in risk groups justified? A fourteen-year follow-up with special focus on compliance and quality of life. Aliment Pharmacol Ther 2005;22(4):317-24.