The Efficacy of Probiotics and Prebiotics in the Management of Coeliac Disease: A systematic review

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Abstract Background: Coeliac disease (CD) is an autoimmune disorder associated with dietary gluten. It is estimated to affect up to 1% of the global population. CD causes pathological destruction of the intestinal mucosal lining, with characteristic villi atrophy, hyperplasia of the crypts, and inter-epithelial lymphocytosis. CD is also associated with dysbiosis in the gut microbiome. CD presents with both gastro-intestinal (GI) and systemic symptomatology. The mainstay management of CD is adherence to a gluten-free diet (GFD). While GFD confers various reported benefits to CD patients, the approach is faced with its challenges, including varied adherence, with associated development of complications such as vitamin deficiencies. Better comprehension of CD pathogenesis has led to the development of new therapies for CD treatment, including probiotics and prebiotics. Objective: The review assessed the reported patient outcomes when probiotics and/or prebiotic were incorporated into the dietetic management of adult and paediatric CD. Also, the role of the dietitian in CD patients and associated benefits Methodology: The systematic search was conducted on MEDLINE, PubMed, and the Cochrane Library (CENTRAL). The Inclusion criteria included studies published between 2012 and June 2019 in both paediatric and adult human patients with diagnosed CD, using probiotics and prebiotic either given alone or in conjunction with the GFD. The quality assessment was by Cochrane Collaboration’s criteria tool, a number of randomised clinical trials (RCTs) were identified with 10 being selected for the review. Adult ages ranged from 18 to 75years; paediatric ages ranged from 1 to 19 years. Result: Probiotic and prebiotic use was used both as a standalone therapy, or in conjunction with the GFD. Reported positive outcomes associated with probiotic use were improvement CD associated GI symptomatology (intestinal inflammation, constipation, visceral hypersensitivity, indigestion, and reflux), immunomodulation, and restoration of the gut microbiome with no reported side effect. Conclusion: Prebiotic use was beneficially associated with improvement of nutritional status and biochemical parameters; improvement of intestinal microbiota. On the other hand, the probiotic use was useful in improvement intestinal permeability; improvement of GI symptomatology associated with CD, with no reported side effects for both. However, most of the studies were pilot studies, had various limitations, and literature in the area was still in the early stages and hence sparse. Dietitian use is not associated with disease severity, adherence to the GFD, or QOL; however, delay in CD diagnosis associated with poorer outcomes. Future studies are needed to further explore the mechanisms underlying the realized positive association between probiotic and prebiotic use and improvement of GI and systemic symptomatology associated with CD. Keywords: coeliac disease (CD), pathogenesis, gluten free diet (GFD), prebiotics, probiotics, gut microbiota, Microbial.