Effect of Parabiotics as an Adjuvant in Nutritional Management of Pediatric Celiac Patients

Background: Celiac disease (CeD) is an immune-mediated enteropathy triggered by dietary gluten in persons possessing human leukocyte antigen (HLA)-DQ2 or DQ8. the loss of gluten tolerance may manifest upon its dietary introduction or at any point in life, with the underlying process still under investigation. The involvement of an environmental factor in CeD pathogenesis is substantiated by the observation that HLA and non-HLA genes account for merely 55% of disease susceptibility.
Aim of the Work: The primary aim of our study was to assess the safety of parabiotic supplementations in the nutritional management plan of pediatric patients with celiac disease. The secondary aim of our study was to explore the additional benefit of parabiotic supplementation in the nutritional management of paediatric patients with celiac disease regarding GIT symptoms.
Patients and Methods: This study included 30 celiac patients aged 3 to 17 years recruited from Pediatric Clinical nutrition and Gastroenterology Outpatient Clinics, Children`s Hospital, Ain Shams University. Patients followed strict gluten free diet regimen for 3 weeks then parabiotic was added for another 3 weeks, at these points, patients underwent complete physical examination, and detailed history had been taken laying stress on GI symptoms.
Results: This study evaluated parabiotics in 30 pediatric CeD patients who showed significant improvements in different gastrointestinal (GI) symptoms but there was further comparatively little improvement when parabiotics were added in comparison to GFD alone except in sense of bloating, which showed gross improvement with parabiotics use (48.10% vs 32.26% decrease). Albumin and total protein levels improved (p<0.01) throughout follow up, while anthropometric changes were not significantly detected.
Conclusion: The integration of parabiotics into the nutritional management of pediatric celiac patients could have a positive impact on gastrointestinal symptoms especially sense of bloating. long-term follow up studies with larger sample sizes are recommended to explore the sustained benefits of adding probiotics to GFD.