John Mayberry

Adherence to a Gluten Free Diet Is Associated with Receiving Gluten Free Foods on Prescription and Understanding Food Labelling

Treatment of coeliac disease requires a strict gluten-free (GF) diet, however, a high proportion of patients do not adhere to a GF diet. The study explores the practical challenges of a GF diet and dietary adherence in Caucasian and South Asian adults with coeliac disease. Patients with biopsy- and serology-proven coeliac disease were recruited from a hospital database. Participants completed a postal survey (n = 375), including a validated questionnaire designed to measure GF dietary adherence. Half of Caucasians (53%) and South Asians (53%) were adhering to a GF diet. The quarter of patients (n = 97) not receiving GF foods on prescription had a lower GF dietary adherence score compared with those receiving GF foods on prescription (12.5 versus 16.0; p < 0.001). Not understanding food labelling and non-membership of Coeliac UK were also associated with lower GF dietary adherence scores. A higher proportion of South Asian patients, compared with Caucasians, reported difficulties understanding what they can eat (76% versus 5%; p < 0.001) and understanding of food labels (53% versus 4%; p < 0.001). We recommend retaining GF foods on prescription, membership of a coeliac society, and regular consultations with a dietitian to enable better understanding of food labels. Robust studies are urgently needed to evaluate the impact of reducing the amount of GF foods prescribed on adherence to a GF diet in all population groups.

Review: Statutory regulation of invasive complementary therapies, such as hijama and acupuncture, is the only effective way of ensuring both patient safety and good practice:

The development of statutory regulation of healthcare professionals first emerged in the 15th century in the UK. However, it was not until the 20th century that statutory regulation of complementary therapies emerged with the Osteopath and Chiropractors Acts. However, during that period, acupuncture failed to gain statutory regulation but was rather subject to the equivalent of trading standards. This review explores the background to this failure and the present need for statutory regulation. It draws comparisons with the need for regulation of hijama, another invasive therapy, for which there is at present no regulation. The benefits of the negative licensing model developed in Australia are considered.

PWE-100 Challenges in adhering to a gluten free diet in different ethnic groups

Introduction The treatment for Coeliac Disease (CD) is a lifelong strict gluten free diet (GFD) to prevent comorbidities. Patients refer to both social and practical challenges with adhering to a GFD (Lerner, 2010). There is very limited research exploring the challenges of a GFD in ethnic populations residing in the UK. This study aimed to determine if the challenges in dietary adherence to a GFD were similar for South Asian (SA) and White Ethnicity (WE) populations with CD. Methods A combined cross sectional survey using validated questionnaire and CD adherence score (Leffler) and review of clinical and laboratory data was utilised. A score of 13 or less was used to determine the non-adherence (Mooney et al. 2014). 972 (histologically confirmed CD) patients (85% White, 86% Female) were approached through postal route. Semi-structured mixed qualitative and quantitative method telephonic interviews were conducted in 28 patients with CD not adhering to a GFD (SA=7, WE=21). Results SA (13; 10–19, n=38) and WE patients (13; 10–19, n=375) with CD (13; 10–19, n=375); 52.2% and 52.6% respectively were categorised as adhering to a GFD.Abstract PWE-100 Table 1 Agreement with statements by South Asian and White ethnicity patients with coeliac disease % responses in agreement with the statements P valuea White ethnicity n=375 South Asiansn=38 I don’t understand what foods I can eat 4.5 76.3 <0.001 I don’t understand food labelling 3.9 52.6 <0.001 Gluten free foods are unpleasant 57.0 81.6 0.003 a Chi squared Interviews with patients not adhering to a GFD highlighted 54% of WE indicated motivation as a challenge compared with 33% of SA, whereas, 77% of SA indicated contamination as an issue compared with 4% of WE patients. Both SA and WE patients found eating out difficult (80% and 86% respectively), with the majority of each group indicating a lack of confidence in the knowledge of restaurant staff (85% and 66% respectively). 85% of SA patients with CD reported not finding GF foods in their local Asian stores Conclusions Our study highlights that there are substantial issues with the understanding of food labels that impact adherence to a GFD. Furthermore, the absence of GF foods in local Asian stores is likely to reduce adherence. More research is required to quantify the low availability of GF foods in local Asian stores. References . Lerner, A. New therapeutic strategies for celiac disease. Autoimmunity Reviews2010;9(3):144–147. . Mooney, P. D., Leeds, J. S., Libzo, et al., (2014) Case-finding for coeliac disease in secondary care: Digestive and Liver Disease: Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. 46(1):32–35.

PWE-104 Vitamin D in Inflammatory Bowel Disease. A Semi-Qualitative Assessment of the Patient Experience

Introduction Vitamin D plays a vital role in bone health, immune regulation and cancer prevention in inflammatory bowel disease (IBD). Our understanding has increased remarkably in the past decade, although the mechanism of its influence in IBD remains unclear as does its role in treatment. Although the efficacy of vitamin D as an immunomodulator remains to be established, given current evidence it appears reasonable to screen and treat vitamin D deficiency in patients with IBD. Methods Two hundred consecutive patients with vitamin D deficiency were identified from IBD clinics at Leicester General Hospital who had been seen during a 12 month period. A postal questionnaire was sent to these patients. It was anonymous and requested whether: Respondents believed they had been told of their vitamin D deficiency. General practitioners had prescribed vitamin D supplements. Vitamin D supplements had been bought at local pharmacies. Brand of vitamin D supplements taken. Compliance with treatment. Symptoms had improved with treatment. They had enough sunlight exposure Results Ninety eight of the 200 patients responded to the questionnaire, a reponse rate of 49%. Sixty five were English and 33 Asian. The response rate was 48% in Asians and 50% in English which is not significantly different. Seventy (71%) of the 98 patients, recalled being told they were vitamin D deficient. Thirty nine patients (40%) believed they had sufficient exposure to sunlight. 54 (71%) had been prescribed this medication by general practitioners and 22 (29%) had bought vitamin D supplements over the counter at local pharmacies or herbal stores. General practitioners predominantly prescribed Adcal D3 tablets. Sixty four (84%) patients said they were adherent to vitamin D treatment. Symptoms improved significantly in 29 (38%) patients. However, this figure rose to 45% when only those 64 patients who were compliant with therapy were considered. Conclusion Vitamin D plays a significant role in intracellular functions which extends beyond its effects on bone metabolism. It is an important regulator of the immune system which may have implications for the development, severity and management of immune related disorders such as IBD. In summary the relationship between the vitamin D axis and IBD is multifaceted. It should comprise maintainence of musculoskeletal health and control of disease through immunomodulation and modification of associated malignancy. Disclosure of Interest None Declared. Reference Vitamin D and inflammatory bowel disease – established concepts and future directions Alimentary Pharmacology and Therapeutics (2012) 36, 324–344 M.Garg, J.S.Lubel, M.P.Sparrow, S.G. Holt & P.R. Gibson 2. Vitamin D as a therapy for colitis A systematic review Journal of Crohns & Colitis (2012) 6, 405–411 I Nicholson, A. Mark Dalzell, Wael El-Matary.