MAgnetic Resonance imaging in COeliac disease (MARCO) Version 1.0
Research type
Research Study
Full title
MRI assessment in newly diagnosed coeliac disease and following gluten free diet treatment
IRAS ID
172522
Contact name
Carolyn Costigan
Contact email
Sponsor organisation
University of Nottingham
Duration of Study in the UK
3 years, 0 months, 0 days
Research summary
Summary of Research
One in 100 people suffers from coeliac disease. It affects the lining of the bowel and causes many symptoms such as diarrhoea, wind, stomach pain, constipation and nausea. The only treatment so far is a strict gluten-free diet for life which reverses the bowel damage and often improves symptoms. Up to 25% of patients however may have persistent symptoms despite the gluten-free diet but the reasons for this are not clear.This research aims to help us understand how the gluten-free diet works. We will use medical imaging (magnetic resonance imaging or MRI) to measure the volumes of fluid in the small bowel, the size of the large bowel and the time it takes for foods to go through the entire bowel in patients who have just been diagnosed with coeliac disease by their hospital doctor. We will also carry out a breath test and collect a stool sample for basic analysis of the stool bacteria. We will also collect questionnaires about their feelings and their bowel habits. We will try to see how the MRI measurements relate to the patients’ symptoms. We will observe how all these measures change after one year of the gluten-free diet that doctors will have prescribed as part of the coeliac patients’ standard care. As such there is no dietary intervention in this study, we will simply study changes in the patients due to their standard treatment. We will also look at a matched group of healthy volunteers to gather a likely reference range of the measurements. This research will be carried out in Nottingham with the help of the specialist coeliac clinics and it will last 3 years.
Summary of Results
The main aim of the study was to improve our understanding of the effect of a gluten free diet on the bowel in Coeliac disease. We did this by looking at any change following treatment with a gluten-free diet (GFD) in:
1. the water content of the small bowel (measured in the morning having fasted overnigh)t 2. the volume (size) of the colon (measured in the morning having fasted overnight) 3. the time it takes to food to travel through the gut (the gastrointestinal transit time) in adults newly diagnosed with coeliac disease using non-invasive MRI techniques.
We also looked at in healthy volunteers (HVs), selected to be of the same age and sex as the patients. They did not undergo a gluten-free diet
36 People over the age of 18 who had recently been diagnosed with coeliac disease, and s36 healthy volunteers the same age and sex took part in the study. This was an observational study so the patients had no extra treatments besides their gluten free diet.None of the participants had any adverse reactions during the study They attended for an MRI visit having fasted overnight. Bowel water content, colonic volumes and transit times through the digestive syatem were measured. Symptoms, expired breath hydrogen, stool diaries and stool samples were also collected. This was then repeated at 12 months follow-up.
This study in patients with new coeliac disease has shown for the first time that treatment with a gluten free diet for a year reduces the small bowel water, significantly reduces the overall colon volume and decreases the whole gut transit time.
The coeliac patients also have greater SBWC than healthy controls at baseline and at follow up. Also the colon volumes are also larger at the time of diagnosis of coeliac disease and reduce over 12 month follow up on a gluten free diet.
Finally, there is a significant reduction in whole gut transit time following a gluten free diet in the coeliac patients.
Quality of life reported by the coeliacs patient was poorer than that in the healthy controls, even following GFD treatment. GI symptoms were significantly greater at baseline than at follow-up for the coeliac patients and although had improved following the GFD were still significantly higher than the controls at both time points. This study in patients with incident coeliac disease has shown for the first time that treatment with a gluten free diet for a year reduces the small bowel water, significantly reduces the overall colon volume and decreases the whole gut transit time.
The increased SBWC in coeliacs before and after treatment compared to healthy controls may represent an imbalance between absorption and secretion due to the damaged villi.
.These results show that MRI can be a useful non-invasive tool in evaluating coeliac patients and this work can add to our understanding of coeliac disease. This work provided also a new method to calibrate and standardise such small bowel water volume quantitation between scanners and laboratories For public and patient involvement we formed a Coeliac Disease focus group for this research, with patients and carers sharing their lived experience of the disease and diagnosis. They commented on the study design and contributed to the design and content of Participant Information Sheets. They were very enthusiastic about the project and continued to help during the research. They also helped in publicising the study, and will help with dissemination of the findings in non-traditional ways beyond scientific meetings and journals.REC name
London - Surrey Research Ethics Committee
REC reference
15/LO/0253
Date of REC Opinion
10 Feb 2015
REC opinion
Favourable Opinion