Understanding why some patients don’t feel better

Project title: Understand why some patients with coeliac disease don’t feel better despite being on a gluten free diet 

Professor Ramesh Arasaradnam is a Consultant Gastroenterologist at University Hospitals Coventry & Warwickshire and clinical academic at the universities of Coventry, Leicester and Warwickshire. His research interests focus on inflammatory conditions within the gastrointestinal tract and the application of non invasive technology for early disease diagnosis.

What was the main issue your research was seeking to address?

We aimed to study the ‘chemical signature’ of cells and gut bacteria in people newly diagnosed with coeliac disease and observe any subsequent changes in these six months after people have been established on a gluten free diet.

Our hypothesis was that changes in the gut bacteria may explain, at least in part, why some patients with coeliac disease do not feel better despite following a gluten free diet.

What were you hoping to find out through this research?

We were hoping to identify ‘chemical signatures’ in people newly diagnosed with coeliac disease, which might then alter/normalise after being established on a gluten free diet. We were specifically hoping to find these changes using non-invasive methods such as a urine test. Secondly, we were hoping to show that this change in chemical signature mirrors the change in gut bacteria pattern before and after commencing a gluten free diet.

How successful was the project in achieving this?

We demonstrated that with a urine sample we can detect differences in the chemical signature pattern before and after starting a gluten free diet within the same individual. This is important as we have a simple test (urine) that can potentially track a patient with coeliac disease throughout the course of their condition.We also identified four key chemicals that were present in people with coeliac disease that were not present in the control group(people without the condition). However, the significance of these chemicals and what it means in terms of cell activity for people with coeliac disease, needs to be studied further.

We also showed that the gut bacteria in those who were established on a gluten free diet altered to become a more ‘normal’ pattern.

How will this project benefit patients?

The learning from better understanding the chemical signatures and gut bacteria in people who respond well on a gluten free diet could potentially be applied to modify gut bacteria in patients that do not achieve full symptom response or experience symptom relapse on a gluten free diet.These findings are novel and set the scene for further detailed studies on understanding what happens to those with coeliac disease, who then commence a gluten free diet and respond at the cellular level, as well as what happens to their gut bacteria.

What are the next stages for this work?

There are several avenues that we can pursue:

• Validate our findings by looking at the changes in the chemical signatures, before and after a diagnosis of coeliac disease, in another group of people with the condition
• Further determine the importance of the four chemicals in urine that we have identified in people with coeliac disease
• Explore the gut bacteria further, especially their metabolic function and if it’s linked to the chemicals identified
• Eventually as a treatment option, to look at gut bacteria supplementation as we gain understanding of what a ‘normal’ or healthy bacterial population should look like