Strike 3 against the gluten theory: you're out!

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Gastroenterology. 1997 Jun;112(6):1830-8.

The prevalence and causes of chronic diarrhea in patients with celiac sprue

treated with a gluten-free diet.

Fine KD, Meyer RL, Lee EL.

Division of Gastrointestinal Research, Baylor University Medical Center,

Dallas, Texas 75246, USA.

BACKGROUND & AIMS: The majority of patients with celiac sprue experience

diarrhea before diagnosis. There have been no studies of the prevalence or

causes of chronic diarrhea in these patients after treatment with a

gluten-free diet. METHODS: Seventy-eight patients with celiac sprue (59

women and 19 men) treated with a gluten-free diet for at least 12 months

were surveyed about their bowel habits. Those with chronic diarrhea,

defined as passage of loose stools three or more times per week for 6

months, underwent an extensive diagnostic evaluation to determine its

cause. RESULTS: Sixty-two of the 78 patients (79%) experienced diarrhea

before treatment, and 13 (17%) had chronic diarrhea (of lesser severity)

after treatment. The causes of diarrhea in 11 patients consenting to this

study were microscopic colitis, steatorrhea secondary to exocrine

pancreatic insufficiency, dietary lactose or fructose malabsorption, anal

sphincter dysfunction causing fecal incontinence, and the irritable bowel

syndrome. Only 1 patient had antigliadin antibodies detected in serum or

small intestinal villous atrophy. CONCLUSIONS: After treatment of celiac

sprue with a gluten-free diet, chronic diarrhea persists in a substantial

percentage of patients. Although ongoing gluten ingestion is one possible

cause, other causes may be more frequent. Therefore, diagnostic

investigation of diarrhea in celiac sprue after treatment seems warranted.

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