A Prospective Cohort Study of Reactions to Gluten 6 Months After Diagnosis of Celiac Disease
Bibliographic record
Abstract
Introduction: Reports of gluten-free diet adherence among patients with celiac disease vary widely. The aim of this study is determine the prevalence and characteristics of reactions to gluten among patients with celiac disease who have been trying to follow a gluten free diet for 6 months. Methods: Adults with positive celiac serology (TTG and/or EMA antibodies) and Marsh II-III histology were prospectively enrolled. A survey with items related to diet adherence and reactions to gluten was completed at study entry and 6 months thereafter. The Celiac Symptom Index (CSI) and the Celiac Diet Assessment Tool (CDAT) were used to measure celiac disease symptoms and GFD adherence, respectively. Results: 81 patients (70% female) completed both questionnaires. Mean age was 41.4 years (SD 16.7). At 6 months, 94% reported gluten exposure < 1 per month and mean CDAT score was 12.4 (SD 3.5), consistent with adequate adherence. Over 60% reported a symptomatic reaction to gluten. Gluten consumption was unrecognized until a reaction occurred (62%) or resulted from problems ordering in a restaurant (34%). The amount of gluten consumed ranged from unknown (36%) or cross-contamination only (30%) to a major ingredient (8%). For the majority (51%) symptoms occurred within one hour (range 10 min to 24 hours). There were 19% who did not develop symptoms until 24 hours or more after gluten exposure (range 1 h to 8 days). Common symptoms included diarrhea (45%), constipation (26%), fatigue (36%), irritability (34%) and headache (34%). Reactions at six months were associated with more severe symptoms (70%) triggered by less gluten (49%) than at diagnosis. Many patients had difficulty discerning whether symptoms were related to gluten ingestion or some other cause. Conclusion: Reactions attributed to gluten ingestion are frequent among patients with CD who have been trying to follow a GFD for 6 months. The onset is within 24 hours and symptoms may be gastrointestinal or extraintestinal. Most did not know that they had consumed gluten until they experienced symptoms. Studies in which actual gluten consumption is measured prospectively would be helpful to determine whether reactions reported by patients correspond with gluten exposure.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".