Paediatric Gastroenterology Unit.
Department of Biological, Geological and Environmental Sciences, University of Bologna.
J Pediatr Gastroenterol Nutr. 2020 Jul;71(1):78-82. doi: 10.1097/MPG.0000000000002676.
Assessment of adherence to gluten-free diet in celiac disease (CD) is generally recommended. Few data are available about consequences of transition from the referral center to the general pediatrician (GP) once remission is achieved.
Adherence was assessed in patients referred to the GP for an annual basis follow-up, called back for re-evaluation. Immunoglobulin A (IgA) antitissue transglutaminase (anti-tTG) antibodies and the Biagi score (BS) were determined at last follow-up at the referral center (V1), and at re-evaluation (V2). Patients were classified as adherent (BS 3-4, IgA anti-tTG <7 U/mL) and nonadherent (BS 0-2, IgA anti-tTG ≥7). Scores of adherence were correlated with personal and clinical data.
We evaluated 200 patients. Overall, we found good adherence rates in 94.95% of patients at V1 and 83.5% at V2. IgA anti-tTG were negative in 100% at V1 and 96.97% at V2. BS is 3 to 4 in 94.5% at V1 and 84% at V2. Adherence at V2 was significantly worse than V1 (P < 0.001). No significant associations were found between scores of adherence and sex, symptoms and age at diagnosis, family history of CD, comorbidity, and diagnosis by endoscopy. Age 13 years or older represents a risk factor for lack of compliance at V1 (P = 0.02) and V2 (P = 0.04), and foreign nationality at V2 (P = 0.001).
The BS, serology, and a clinical interview, integrated, are reliable tools for assessing pediatric adherence to gluten-free diet. We argue that referring patients to the GP after remission of CD is important, but the process must be improved and recommendations are required.
一般建议对乳糜泻（CD）患者进行 gluten-free diet 依从性评估。在达到缓解后，从转诊中心过渡到普通儿科医生（GP）时，有关依从性的后果的数据很少。
在患者被转诊到 GP 进行年度随访时，我们对其进行评估，以便进行重新评估。在转诊中心的最后一次随访（V1）和重新评估（V2）时，测定免疫球蛋白 A（IgA）抗组织转谷氨酰胺酶（anti-tTG）抗体和 Biagi 评分（BS）。将患者分为依从组（BS 3-4，IgA anti-tTG <7 U/mL）和不依从组（BS 0-2，IgA anti-tTG ≥7）。将依从性评分与个人和临床数据相关联。
我们评估了 200 例患者。总体而言，我们发现患者在 V1 时的依从率为 94.95%，在 V2 时为 83.5%。V1 时 IgA anti-tTG 为 100%阴性，V2 时为 96.97%阴性。V1 时 BS 为 3 至 4，V2 时为 84%。V2 时的依从性明显差于 V1（P<0.001）。在依从性评分与性别、症状和发病年龄、CD 家族史、合并症以及内镜诊断之间，未发现显著相关性。13 岁或以上是 V1（P=0.02）和 V2（P=0.04）时缺乏依从性的危险因素，并且在 V2 时是外国国籍（P=0.001）。
BS、血清学和临床访谈综合起来是评估小儿 gluten-free diet 依从性的可靠工具。我们认为，在 CD 缓解后将患者转介给 GP 非常重要，但该过程必须得到改善，并需要提出建议。
