Evaluation of Dietary Compliance of Patients with Celiac Disease in Gaza Governorates

Nahla Hamad Abu Amer
نهلة حماد احمد ابو عامر
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Al-Quds University
Background: Celiac disease is an inflammatory disorder of the small intestine, which is characterized by mucosa inflammation, villous atrophy and malabsorption. Aim: To assess the dietary compliance to gluten free diet (GFD) status of registered celiac patients at Ard El Insan in the Gaza Strip, in order to improve the diet compliance among them. Methods: The design of the study was descriptive, analytical, cross sectional one. The study included all patients who were diagnosed by either antibody test or intestinal biopsy from both sexes among all patients attending Ard El Insan clinic, according to the celiac disease care medical records in the year 2011. Data was collected through interviewed questionnaire completed by one hundred thirty five patients. The response rate among study population was 70%. Result: The mean age was 26 years old, and 71% were female. The frequency of Celiac Disease in adults was 64%, and 39% of patients were from Gaza city, and 38% from the south. Medium level of education among patients constituted 46% against 20% with low level of education and 27% with high level. About 44% of patients were not working against 25% with occupation. Mean period of symptoms was 56 months before diagnosis, and mean duration of CD was 8 years. The median age of diagnosis was 21 years with a range from 1 to 64 years. Presenting symptoms included weight loss (86.7%), bloating (83.7%), abdominal pain (83%), diarrhea (79.3%), poor growth (75.6%), gases (71.9%), vomiting (45.9%), itchy skin (30.4%), constipation (25.2%), and lactose intolerance (20.7%). The final diagnosis was by gastroenterologist among 67% of patients against 27% by pediatrician. A serological test was performed to diagnose CD in 79% of the study population against 64% by intestinal biopsy. More than half of respondents (58%) reported strict adherence to a gluten-free diet, and 62% noted improved health. Almost the majority of study population (70%) didn t hear about CD before. Thirty-eight percent of the respondents didn t know if CD can be cured completely against 21% thought that CD cannot be cured completely. More than half of respondents didn t know the special logo of gluten-free food, and half of them reported lack in knowledge of determining if foods were free of gluten. Ard El Insan provided excellent information for 89% of respondents. The majority of study population (73%) avoided restaurants. Only 28% avoided going out. Eighty-seven of the respondents reported extreme difficulty in finding gluten free foods. When asked to select two items that would improve their quality of life, earlier diagnosis of celiac disease was selected by 85%, better dietary counseling by 39%, more gluten-free foods in the supermarkets by 37%, better labeling of gluten containing foods by 24%, and gluten- free choices on restaurant menus by 14%. The study showed that the more knowledgeable patients the more compliant they were (P-value = 0.044). Also there were a statistically significant differences in reference to compliance and the patients attitudes (Pvalue = 0.003). Conclusion: In the Gaza strip, patients with celiac disease present at all ages with a variety of symptoms. Delay in diagnosis was common. More than half of respondents were compliant with a gluten-free diet. The study proved the importance of knowledge and attitudes to achieve compliance among respondents. A gluten-free food was difficult to obtain. The study recommends regular availability of GFD and to improve the case detection.