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Persistent Mucosal Abnormalities in Coeliac Disease are not Related to the Ingestion of Trace Amounts of Gluten

Scand J Gastroenterol 1999 Sep;34(9):909-14
AW Morrow Gastroenterology and Liver Centre, Dept of Histopathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.

SPECIAL NOTE: European Codex Alimentarius quality wheat starch was used in this study.

(Celiac.com 06/25/2000)

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BACKGROUND: It is expected that in patients with coeliac disease the small bowel mucosal mucosa will return to normal if they adhere to a gluten-free diet (GFD). However, in many this is not the case. This study aims to determine whether this persistent villous atrophy (VA) could be due to continued ingestion of the trace amounts of gluten in gluten-free foods, as defined by the WHO/FAO Codex Alimentarius.

METHODS: Duodenal biopsy specimens from 89 adults with long-standing coeliac disease were examined, and the findings correlated with their form of gluten-free diet.

RESULTS: In 51 subjects the duodenal specimen was normal, whereas in 38 there was villous atrophy (partial, 28; subtotal, 8; total, 2). There was no relationship between the presence or absence of VA and ingestion of either a GFD as defined by the Codex Alimentarius (Codex-GFD; 39 patients) or a GFD that contained no detectable gluten (NDG diet: 50 patients). Intraepithelial lymphocyte counts were higher, and lactase levels lower, in subjects with an abnormal biopsy specimen than in those in whom it was normal. However, within each of these biopsy groups there was no difference in these variables between patients on a Codex-GFD and those on an NDG-GFD. IgA antigliadin antibody was detected in 4 of 29 patients on a Codex-GFD and in 3 of 13 on a NDG-GFD (NS).

CONCLUSION: The persistent mucosal abnormalities seen in patients with coeliac disease on a GFD are not due to the ingestion of trace amounts of gluten. The consequences of these abnormalities have yet to be determined.

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2 Responses:

 
Ginger
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said this on
15 May 2008 12:25:28 PM PDT
This is the conclusion I've come to after eliminating almost all packaged, bottled and boxed foods and solely eating vegetable, fruits, and seafoods. Now and then I have coffee but I'm hoping that's not bad. So far the ingestion and discomfort is mild or minimum but I've noticed the indigestion is still current. It's difficult to break down beef and large portions of food even when I'm craving/hungry for that amount. So this tidbit of an article does make sense and confirm that I'm not getting 'mysterious' gluten traces from my coffee...hopefully not, and that I need to pursue this diet I'm on to heal my guts. But for how long?

 
Judith
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said this on
08 May 2012 4:58:35 AM PDT
I'm glad I found this article. I am still having slight symptoms. It really bothers me but I also feel that it takes 3-6 years to heal and I'm not there yet. Also, my symptoms are as much from my diabetes I think (peripheral neuropathy).




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The Rash and various other symptoms are strong signs of Celiac, multiple people in your family also have it. I see several of your symptoms as very familiar to me myself, and I know that supplementation will help resolve the rest of your issues with a gluten-free diet. While we do suggest getting tested for confirmation if your limited as you say with insurance, and money then doing what is best for your health should be your focus right now. Go ahead and remove the gluten from your diet if you wish and go gluten free. If something happens later you MIGHT be able to put up with a gluten challenge and get tested at a later time. I feel for you and see the issues, I have Medicaid myself and my severe gluten reactions and allergies got me on disability for a good while. Testing was a pain in the ass for me as finding a doctor that takes Medicaid is bloody near impossible where I live. I do suggest supplementing Magnesium, Iron, Vitamin D, and B vitamins primarily right now. Others you might be low in are folate, E,C,A and various others. The nerve issues are strongly related to various b vitamins, magnesium, and D. I will share a link of what I take for a example. BTW have you checked out the newbie 101 thread? And if you need help finding gluten-free foods I have a huge list that I have complied for people although we normally suggest a whole foods diet only for the first month or so. Might want to drop dairy and oats for a bit, by the sound of your deficiency issues I would say it would be a huge help doing so. https://www.celiac.com/gluten-free/topic/117090-gluten-free-food-alternatives-list/ https://www.celiac.com/gluten-free/topic/116482-supplement-and-foods-you-take/

It is meant to show you are a real person not a spammer. Not sure if it works anymore. Only Admin can see it and he doesn't do anything with it.

MelissaNZ, Has your daughter been checked for vitamin deficiencies??? Vitamin D deficiency symptoms include urinary incontinence, oral candidiasis (thrush), skin rashes, bumps on the backs of arms, joint pain, distended stomach and short stature. Bones can't grow much without vitamin D. Vitamin D deficiency causes delayed gastric emptying (food doesn't move through the gastrointestinal tract at a normal speed and the intestines bloat) which explains your daughter's delayed reaction to the cake. Vitamin A deficiency is also a cause of bumps on the back of the arms. Vitamin A deficiency causes vision problems. Vitamin A and D are both fat soluble vitamins. Absorption of fats is a problem for Celiacs. So is absorption of B vitamins and important minerals. B Complex vitamins are water soluble and must be replenished every day. Skin rashes are associated with several B vitamins like niacin (B3), B12, and thiamine (B1). I went through a period of severe malnutrition prior to diagnosis. It was not a pleasant experience. I had symptoms similar to your daughter's, including the incontinence, which resolved on vitamin D supplementation. Please, please have your daughter tested for vitamin D deficiency. And have her B vitamins checked as well. Celiac Disease causes malabsorption. Malabsorption causes deficiency diseases. Newly diagnosed Celiacs need to be checked for deficiencies. I hope this helps.

I will try to make my long story short, I have been searching my whole life for a diagnosis, I have seen pretty much every doctor possible I even went through a spinal tap recently because they thought I had multiple sclerosis, when I was younger I was always throwing up and having stomach problems, a couple hospital visits they thought I had appendicitis, I started having a neurological symptoms as well as anxiety and depression, The fatigue was just over bearing, I was having numbness and tingling and muscle spasms all the time eventually started having seizures, which kind of cycled through and stop happening after a couple months, and then it dawned upon me my brother has celiac pretty severely, my grandmother also has celiac, my dad does as well, I don't know why I never thought that it could be my issue, for the last week I have Been gluten-free and steering clear of cross-contamination, my dizziness is improved my fatigue is improved as well as rashes I was getting on my arms and sides, I have no more muscle jerks or spasms, The problem is I have horrible insurance and I cannot afford testing, so I am at least trying to do it an home blood test, I know it's not very accurate on telling me if I have celiac or not, But the thought I may never know for sure if I have it is very daunting. My family keeps telling me you don't need to spend thousands of dollars to have a doctor tell you you can't eat something you already know you can't. Just was wondering if anybody else has been in my position and seeing if anybody has a vi just was wondering if anybody else has been in my position and seeing if anybody has advice, I don't want to be known as one of those people who believe they have something and people with the disease frown upon them it's a very scary thing to think about.

...ON a side note this is quite easy, you can make your own out of any gluten-free Bread mix, I recently started using a coconut flour blend for this.......Most often people associate caraway with Rye Bread so you just add caraway seeds to the dough and a bit more vinegar to sour it a tad and BAM gluten-free Rye Bread knock off. I think Authentic Foods even has a additive to put in bread mixes to make it taste like Rye Bread....Or you can buy it preamade, I have issues with all the other ingredients but as for one of the best gluten-free Breads out the Canyon House makes a Rye like bread https://canyonglutenfree.com/buy-gluten-free-bread-products/Gluten-Free-Rye-Deli-Sandwich-Bread.html