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  • Jefferson Adams
    Jefferson Adams

    Histological, Serological and Symptomatic Responses to Gluten Challenge in Adults with Celiac Disease

    Reviewed and edited by a celiac disease expert.

    Celiac.com 08/10/2012 - A diagnosis of Celiac disease is measured mainly by an adverse response to gluten, yet there is very little in the way of data regarding gluten challenge in adults on a gluten-free diet.

    Photo: CC--rprataA research team recently studied the kinetics of histological, serological, and symptomatic responses to gluten challenge in adults with celiac disease.

    The research team included D. Leffler, D. Schuppan, K. Pallav, R. Najarian, J.D. Goldsmith, J. Hansen, T. Kabbani T, M. Dennis, and C.P. Kelly. They are affiliated with Beth Israel Deaconess Medical Center in Boston, Massachusetts.

    For their study, the team wanted to address a lack of data regarding the kinetics of responses to gluten, which causes assessment issues in clinical practice and research when gluten-challenge is performed.

    For their study, the researchers recruited twenty adults with biopsy-proven coeliac disease. For each participant, the team conducted two run-in visits followed by a 14-day gluten-challenge at a randomly assigned dose of 3 or 7.5 g of gluten/day.

    Patients visited study team doctors at 3, 7, 14 and 28 days after the start of their gluten challenge.

    The researchers performed duodenal biopsy during the run-in and at days 3 and 14 of gluten challenge.

    The team used two pathologists to measure villous height to crypt depth ratio (Vh:celiac disease) and intraepithelial lymphocyte (IEL) count/100 enterocytes. Upon each visit, the team also assessed antibodies to tissue transglutaminase and deamidated gliadin peptides, lactulose to mannitol ratio (LAMA) and any physical symptoms.

    Compared to the initial data, results after 14 days showed substantially lower Vh:celiac disease (2.2-1.1, p

    Interestingly, gastrointestinal symptoms increased significantly after three days, but had returned to baseline by day 28. There were no differences between the higher and lower gluten doses.

    The team concludes by noting that a 14-day gluten challenge at or above 3 g of gluten/day triggers cellular, tissue, and blood changes in most adults with celiac disease.

    These findings will help researchers create more accurate clinical trials, and show that many individuals will meet celiac diagnostic criteria after a basic 2-week gluten challenge.

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    So, how much, say, white bread would one need to consume to meet the 3 grams of gluten criterion? By gluten, do they speak of white flour, 3 grams of bread, or 3 grams of pure gluten?

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    I found it intriguing that intestinal symptoms returned to baseline after 28 days. Many people note an increased sensitivity to gluten after spending some time on a gluten-free diet. I have often wondered if this increased sensitivity would be mitigated after a return to consuming significant amounts of gluten. It would be interesting to know what exactly they meant by baseline. It's hard to imagine that at least some didn't continue with intestinal distress. Maybe gastro symptoms would return after more time on gluten, after more damage has been done. We need more such studies to fully understand the effects of celiac and gluten sensitivity.

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    After 6 months on a totally gluten free diet, a 2-week gluten challenge prior to (positive) biopsy was almost the end of me. I'm glad further research is being conducted.

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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