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How long must gluten be taken for the serological tests to be meaningful?**

Vijay Kumar, M.D., Research Associate Professor at the University of Buffalo and President and Director of IMMCO Diagnostics: There is no simple answer to this question as the susceptibility of the patient to developing celiac disease is dependent upon several factors. One factor is the amount of gluten intake. Another is the genetic makeup of the individual. However, we feel that several weeks of gluten intake, especially in doses of 2 gm gluten/day, should result in positive serology in patients with CD.

Karoly Horvath, M.D., Ph.D., Associate Professor of Pediatrics; Director, Peds GI & Nutrition Laboratory; University of Maryland at Baltimore: The result of serological tests depends on the diet. Generally, three to six months of a gluten-free diet may result in normal antibody levels in a new patient. A strict gluten-free diet for more than three months may result in inconclusive serological tests in patients, who have started a diet without any diagnostic test. In this case a gluten challenge should be introduced for a proper diagnosis.

Each patient has different sensitivity to gluten for reasons that are unclear. The period of gluten challenge and the amount of gluten necessary to provoke serological immune response are individually different.

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A 0.3 g/kg body weight/day of single gluten challenge causes immunological changes (cellular immunity) in the intestine (J Pediatr Gastroenterol Nutr 1989; 9:176-180) in patients on a gluten-free diet, however, the serological response is much slower.

Our recommendation is to ingest at least 0.3 g/kg/day of gluten for two months prior to the serological tests. However, if somebody experiences symptoms during the gluten challenge we recommend to perform serological tests earlier.

The protein content of wheat flour is between 7-15% and approximately 90% of the protein content is gluten. That means a slice of bread may have 2-3 g of gluten.

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3 Responses:

 
DavidJulian
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said this on
13 Jun 2012 1:50:24 PM PDT
Accurate but confusing information. My "executive" summary:
Eating 1 to maximum 2 slices of bread per day, minimum 2 weeks can give enough gluten to render a proper serologic (blood) test. Other factors apply, therefore read full article for important considerations.

 
Beth
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said this on
09 Jun 2015 2:28:55 PM PDT
This was helpful but if I'm having an upper GI and a biopsy, can I eat less gluten to show positive (over the blood test)? I've been off of gluten for a year and not sure it's helping anything but I'm so afraid to go back, however, I don't want to undergo the biopsy and upper GI if it's pointless.

 
james
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said this on
24 Dec 2015 12:58:09 PM PDT
My 5 year old daughter's symptoms point to celiac. After 6 months of symptoms the doctors are finally willing to entertain that there is a problem, blood work came back positive. The G.I. specialist isn’t available for 2 months to meet and schedule a test, another (2 months??). We can't feasibly continue to poison this poor girl waiting for the test as symptoms of distended stomach and malnutrition are apparent already. Knowing that the diet must have gluten to present proper results, we don't feel comfortable continuing behaviour that is damaging.

Question is; does it make sense to stop the gluten diet now, wait for improvement and not preform the test?
Should we resume eating gluten just prior to the testing? Will this still give correct and accurate results?
Continue feeding her gluten and wait for the doctors to become available?

Bear in mind that we have been on a Miralax dose twice the recommended for an adult and still suffer constipation and distended stomach.




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