Nachman et al evaluated the adherence of a patient with celiac disease to a gluten-free diet. If the diagnosis is correct then symptoms should significantly improve if the patient abstains from gluten. The authors are from the Dr. C Bonorino Udaondo Gastroenterology Hospital in Buenos Aires, Argentina.

Intake of Prohibited Food During Month

Level of Adherence

none at all

strict, absolute, excellent

1 to 2 times per month

partial, good

1 to 2 times per week

partial, fair

3 to 5 times per week

partial, poor

every day




• If we assume about 100 meals per month, failure at 1-2 times per month is 1-2% while failure once per day would be 33%.


Differential diagnosis for symptomatic when adherent:

(1) something unrecognized in diet with gluten

(2) additional food allergy

(3) additional gastrointestinal disorder


Differential diagnosis for asymptomatic when nonadherent:

(1) intake less than recognized

(2) wrong diagnosis of celiac disease

(3) very mild disease


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