Gluten-free diet (GFD) decreases the quality of life of celiac disease (CD) patients, who frequently ask to occasionally ingest gluten-containing food. We evaluated CD patients reporting voluntary and occasional transgressions to their GFD. From October 2017 to September 2018, the patients reporting occasional and voluntary gluten ingestion (GFD-noncompliant) were prospectively enrolled. These patients underwent clinical examination, blood tests, duodenal biopsy, capsule enteroscopy (CE), and a validated food-frequency questionnaire (FFQ) assessing the frequency and quantity of gluten intake. Mortality was calculated and compared to the general population. A group of patients on strict GFD (GFD-adherent) acted as controls. One thousand three hundred seventy-eight CD patients were evaluated during the study period. One hundred nine (8%) reported occasional (weekly or monthly) voluntary ingestion of gluten. The mean gluten intake was 185.2 ± 336.9 g/year, and the duration of their incorrect GFD was 8.6 ± 6.9 years. Among the noncompliant patients, 57% did not present any histological alteration; furthermore, the Marsh score profile was not different between compliant and noncompliant patients. Seventy percent did not present any alteration at CE. Seventy-five percent of patients reported no gastrointestinal symptoms after gluten ingestion. Twenty-three percent of patients in the GFD-noncompliant group presented positive tTG-IgA. No association was found between gluten intake, clinical symptoms, and biomarkers. Mortality was not different between the groups and the general population. Our results are that in a real-life scenario, a group of CD patients on long-term gluten intake showed no significant clinical symptoms or small bowel damage, thus suggesting that a degree of tolerance towards gluten consumption can be reached.

中文翻译：

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乳糜泻患者偶尔摄入麸质的安全性：一项现实生活研究。

无麸质饮食（GFD）会降低腹腔疾病（CD）患者的生活质量，这些患者经常要求偶尔摄入含麸质的食物。我们评估了报告其GFD自愿和偶发性侵犯的CD患者。从2017年10月至2018年9月，前瞻性招募了报告偶尔和自愿摄入麸质（不符合GFD）的患者。这些患者接受了临床检查，血液检查，十二指肠活检，胶囊肠镜检查（CE）和经验证的食物频率问卷（FFQ），以评估麸质摄入的频率和数量。计算死亡率并将其与总人口进行比较。一组接受严格GFD（贴有GFD）的患者作为对照。在研究期间对1,387名CD患者进行了评估。一百零九（8％）报告称偶尔（每周或每月）摄入麸质。平均面筋摄入量为185.2±336.9 g /年，其不正确的GFD持续时间为8.6±6.9年。在不依从的患者中，57％没有表现出任何组织学改变。此外，依从性和不依从性患者的Marsh得分特征没有差异。百分之七十没有在CE表现出任何改变。百分之七十五的患者在摄入麸质后没有胃肠道症状。GFD不依从组中有23％的患者呈阳性tTG-IgA。面筋摄入量，临床症状和生物标志物之间未发现关联。人群与普通人群的死亡率没有差异。我们的结果是，在现实生活中，