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Dietetic interventions in non responsive coeliac disease
Nick Trott studied at the University of Wales Institute, Cardiff where he obtained an honours degree in Nutrition and Dietetics. Post graduate training, Nick has worked in a variety of clinical areas within the NHS including critical care, oncology and haematology. Currently Nick works as a gastroenterology dietitian, covering the specialist coeliac clinic at the Royal Hallamshire Hospital, Sheffield. His areas of particular clinical interest include coeliac disease, gluten ataxia, non coeliac wheat sensitivity and the low FODMAPs approach to functional bowel disorders. Nick was presented with the Complete Nutrition Coeliac Professional of the year award in 2016.
A small, but significant, proportion of patients with coeliac disease (CD) continue to have ongoing symptoms and a lack of histological improvement despite apparent adherence to a gluten free diet. Such patients are deemed to have Non Responsive Coeliac Disease (NRCD). Medically these patients require the confirmation of a diagnosis of coeliac disease, exclusion of other causes of symptoms and if necessary the assessment of a possible refractory disease. The most common cited reason for NRCD is of either inadvertent or purposeful exposure to gluten. From this perspective dietetic assessment and guidance plays a crucial role not only in diagnosis but in the treatment of NRCD, through the identification of possible sources of gluten contaminates. Additionally some patients are susceptible to even minute amounts of gluten and require a super sensitive dietary approach. In the last few years new novel dietary treatments have been developed that may also facilitate a reduction in symptoms and improve histological recovery. These approaches are discussed with reference to the low FODMAP and gluten contamination elimination diets.