While it is well known that people with celiac disease have significant improvement in symptoms once diagnosed and on the gluten-free diet – in fact, response to the gluten-free diet is among the criteria needed for an official diagnosis of celiac disease - there is a gap in knowledge regarding what happens when diagnosed patients, after starting and following the diet, do ingest gluten.
This study sought to determine the type and timing of symptoms in biopsy-proven patients with celiac disease after patients report being accidentally exposed to gluten. Researchers distributed a comprehensive written survey via postal mail and 224 patients over the age of 18 with varying degrees of gluten-free diet adherence returned completed questionnaires. Of the 224 study participants, researchers discovered that 32% were at risk for both depression and anxiety and 22% fulfilled criteria for IBS, a co-existing condition that is commonly seen in patients with celiac disease. 70% of survey participants reported full adherence to the gluten-free diet.
The group of patients who were only partially or non-adherent to the gluten-free diet displayed more fatigue, itchy skin, and bloating after being exposed to gluten than those who reported full adherence with the diet. Those with complete adherence to the gluten-free reported more severe symptoms with a faster onset (within an hour) when accidentally exposed to gluten. Those with IBS reported greater fatigue and nausea than those without IBS. Patients with co-existing IBS also reported experiencing symptoms within an hour and were more likely to rate their symptoms as severe than those without IBS. Researchers also identified an association between study participants at risk for both anxiety and depression and an onset of symptoms within two hours of gluten exposure. Additionally, the research team learned that those with a typical GI presentation at diagnosis were more likely to complain of digestive symptoms after gluten exposure post-diagnosis and on the gluten-free diet whereas those with non-GI presentations were more likely to experience headaches as a result of accidental gluten ingestion.
In conclusion, the onset and severity of symptoms varies in patients post-diagnosis and can depend on the level of their adherence to the gluten-free diet. The study authors note, “This may demonstrate that the immune system becomes more adept in its response to gluten following a period of non-exposure that facilitates recovery and/or recuperation.”