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  • Jefferson Adams
    Jefferson Adams

    Study Shows that Celiac-associated Intestinal Degradation May Take Years to Show Up after Reintroducing Gluten into the Diet

    Reviewed and edited by a celiac disease expert.

    Celiac.com 10/30/2007 - Many studies over the years have supported the idea that celiac disease is a permanent condition, and that those who strayed from the strict gluten-free diet that forms the core of celiac treatment risked relapsing and suffering the telltale intestinal damage associated with celiac disease. However, it was generally assumed that symptoms of celiac disease and associated intestinal degradation occurred within two years of reintroducing gluten back into the diet.

    The medical journal GUT recently published a paper by Matysiak-Budnik et al. concerning the natural history of celiac disease, which indicates that classic celiac damage to the intestinal lining may take years or decades to develop in some cases. A team of researchers looked at 61 adults who had been diagnosed with celiac disease as children, and who felt themselves to be asymptomatic for anywhere from 3 to 21 years, with a group average of 11 years. An exam revealed that 48 of the 61 test subjects indeed showed villous atrophy with crypt hypoplasia. The 13 other patients showed no celiac-associated intestinal damage.

    Strangely, 2 of the 13 patients with no signs of damage had showed such damage a short time after gluten was reintroduced into their diets, only to return to normal as they continued to consume gluten. From this, the researchers concluded that some people might actually become truly latent and tolerate gluten with no adverse effects. It’s also possible that such people actually still have celiac disease and that the intestinal damage has yet to recur, as villous atrophy occurs only at the tail end of celiac disease.

    In fact, delayed relapse of celiac disease after gluten reintroduction supports the notion that people with normal mucosa may in fact have celiac disease. Still, it is highly uncommon for patients with celiac disease to show no clinical symptoms on a long-term gluten-inclusive diet. The level of celiac disease+ intraepithelial lymphocytes has proven to be more useful than mucosal Marsh Type 1 lymphocytes in revealing early developing celiac disease in such cases and in general.

    Reliable diagnosis of celiac disease is important, as untreated celiac disease carries a broad range of associated risks including markedly higher rates of certain cancers. A recent study also suggests celiac disease may also adversely impact both the peripheral the central nervous systems.

    However, regarding the 13 asymptomatic patients, the original diagnosis of celiac would seem to be accurate in each case, as each had celiac-type HLA, either HLA DQ2 or DQ8, and their follow-up exam results showed that 5 of those patients had positive serum antibody results and higher densities of small bowel mucosa celiac disease+ and CD3+ intraepithelial lymphocytes than did the non-celiac control groups. Two of the 13 patients developed symptoms of a relapse during the follow-up.

    The study team concluded that the “2 year rule” for reintroducing gluten is invalid and supports the view that celiac disease exists beyond villous atrophy. As villous atrophy of the small intestine is only one manifestation of genetic gluten intolerance, and that the present diagnostic guidelines based on mucosal damage and ignoring early developing celiac disease and dermatitis herpetiformis is only one incarnation of celiac disease.

    GUT 2007; 56:1339-1340

    Katri Kaukinen, Pekka Collin, Medical School, University of Tampere and Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland Markku Ma¨ki, Medical School, University of Tampere and Department of Paediatrics, Tampere University Hospital, Tampere, Finland


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    The conclusions match my experience with celiac disease as far as I can tell. I can cheat on my gluten-free diet and feel joint pain and other autoimmune symptoms for 2 or 3 days without noticing changes in my nutrition after that. In other words my hair doesn't fall out and my skin turn gray from one piece of birthday cake.

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    Does this lead to the conclusion that the 'gold standard' for diagnosis - biopsy proven may be only one indication of celiac disease and that other manifestations should be given equal attention? Concise and informative.

    thanks Jeff.

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    Very informative- mother adheres to gluten free diet more religiously than daughter. Daughter 'falls off the wagon' on occasion. This article lends credence to her side affects.

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    I'm confused - is this article saying that you can go back to eating gluten eventually or not? I was under the impression that once diagnosed as celiac, you could never consume gluten again without damaging your intestines. It sounds like this article is saying that isn't the case. Actually, it sounds like this article's authors are saying two contradictory things - that many patients can go back to eating wheat without any symptoms recurring and that patients should never go back to eating wheat. And, I've never heard of a two-year gold standard for eating gluten again. I just don't think the article is very clear on what the actual implications are for people with celiac disease.

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    After reading the article and comments posted, I can see the source of the confusion. I cannot have a crumb of gluten, and it is very hard sometimes to find the source. I know other celiacs who cheat and I've always told them they are only cheating themselves. When I complained to my doctor once about being so sensitive to gluten, he told me I was the lucky one?? He then told me that at least I knew the damage was being done and could find the source and prevent it. People that aren't aware they are being contaminated by gluten are causing damage to their bodies and don't know it. Celiac disease isn't just a gut disorder, it affects many other body functions. So, if you call that lucky, then I guess I am!

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    Guest Margaret Marchant

    Posted

    I also found it somewhat confusing, but it also contained a lot of information that confirmed what I have experienced. The 2 year rule is new to me, but I'm new to gluten intolerance. Celiac.com is one of my few reliable sources. Thank you for this addition.

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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 biology, anatomy, medicine, science, and advanced research, and scientific methods. 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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