The Impact of a Gluten-Free Diet on Celiac Disease: A Comprehensive Evaluation of Two Cases Using NIH Patient Reported O
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The Impact of a Gluten‑Free Diet on Celiac Disease: A Comprehensive Evaluation of Two Cases Using NIH Patient Reported Outcome Measures (PROMIS, NTCB, and Neuro‑QoL) Jeffrey E. Cassisi1,3 · Emily J. Ross1 · Helize Vivier1 · Nicholas James1 · Le‑Chu Su2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The aim of this study is to demonstrate the effectiveness of the gluten-free diet (GFD) for celiac disease (CD) in a multidisciplinary outpatient Gastroenterology clinic with two adult cases using the innovative, paradigm-shifting measurement systems: The NIH Patient reported outcome measures (PROs). CD results in gastrointestinal (GI) dysfunction, but is also associated with other inflammatory responses, psychosocial impairment, and cognitive deficits such as “brain fog.” Adherence to the GFD for 6 months was associated with improvement in specific GI symptoms in one case (PROMIS-GI; Case 2) and improvement in cognitive functioning (NIH Toolbox Cognitive Battery) and psychosocial functioning (Neuro-QOL) in both cases. Notably, improvement in cognitive flexibility occurred in both younger and an older adult patient. This suggests that cognitive decline and the psychosocial deficits associated with CD are reversible with GFD. The NIH PROs were found to be effective, sensitive to change, and minimally disruptive to clinic operations. Keywords Celiac disease · Gluten-free diet · PROMIS · NIH toolbox · NTCB
Introduction Celiac disease (CD), is caused by an immune reaction to gluten in genetically susceptible individuals (Hujoel, Reilly, & Rubio-Tapia, 2019). Patients with CD can present with many symptoms such as gas, bloating, diarrhea, constipation, nausea, vomiting, abdominal pain, and fatigue. Gluten is found in wheat and in other grains such as barley, and rye, but it is also found in many other food products. Exposure to gluten in individuals with CD leads to an abnormal immune response in several different organs but most importantly the gastrointestinal system (Lundin & Wijmenga, 2015). When gluten is ingested, an inflammatory reaction damages the
* Jeffrey E. Cassisi [email protected] 1
Department of Psychology, University of Central Florida, Orlando, USA
2
Department of Internal Medicine, University of Central Florida, Orlando, USA
3
Department of Psychology, University of Central Florida, 4111 Pictor Lane, Psychology Building 99, Ste. 320, Orlando, FL 32816, USA
villi (slender, vascular projections in the epithelium of the small intestine). When the villi are damaged, their ability to absorb nutrients is disrupted (Di Sabatino & Corazza, 2009). In North America, CD is thought to affect approximately 1% of the population (Rewers, 2005). Variable signs and symptoms make CD difficult to diagnose and estimates suggest that approximately 60 to 90% of affected individuals are not aware of their condition (Collin, Vilppula, Luostarinen, Holmes, & Kaukinen, 2018). CD is slightly more common in women than in men (Wingren, Agardh, & Merlo, 2012). CD has a significan
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