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"Non-Celiacs" Benefit from Gluten-free Diet

Celiac.com 04/14/2009 - A team of Finnish researchers is calling for a change in the criteria for diagnosing celiac disease, based on their findings that gluten intolerant patients who do not have clinical celiac disease get similar benefits from a gluten-free diet, and respond to the diet about as well as patients who do have clinical celiac disease.

The research team recently set out to test their hypothesis that patients who showed only mild enteropathy, but positive endomysial anti-bodies, would benefit from a gluten-free diet in a manner similar to patients with more serious mucosal damage.

The research team was made up of Kalle Kurppa, Pekka Collin, Mervi Viljamaa, Katri Haimila, Päivi Saavalainen, Jukka Partanen, Kaija Laurila, Heini Huhtala, Kaija Paasikivi, Markku Mäki, and Katri Kaukinen, and they are variously associated with Finland's University of Tampere and Tampere University Hospital, the Tampere School of Public Health, the Finnish Red Cross Blood Service, and the University of Helsinki.

Among their findings are that patients with endomysial antibodies benefit from a gluten-free diet REGARDLESS of the level of intestinal tissue damage. That means that folks who have no symptoms whatsoever, but who have blood antibodies that are reacting to offending gluten proteins, should consider the benefits of a gluten-free diet. Moreover, it's likely that damage will eventually occur over time without a gluten-free diet.

The current diagnostic criteria for celiac disease require the presence of small-bowel mucosal villous atrophy with crypt hyperplasia (Marsh III). So, no damage of this specific kind, no celiac disease, no gluten-free diet, no worries. Such has been the common medical practice up to the present.

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However, in many cases, damage to the intestine develops slowly over time. Also, most patients show some kind of clinical symptoms long before histologic changes show up. Endomysial antibodies happen to be strong and specific predictors of pending damage in the form of villous atrophy.

To test their hypothesis, the research team performed small-bowel endoscopies, along with clinical evaluations, on 70 adults with positive endomysial antibodies. Of these, 23 showed only mild enteropathy (Marsh I–II). Researchers assigned members of this group to either gluten-free or gluten-inclusive diets at random.

After 1 year, the team repeated all clinical, serologic, and histologic tests. A total of 47 participants showed small-bowel mucosal lesions consistent with celiac disease (Marsh III), and this group served as a control for the study.

The results for the group that continued to consume gluten showed damage to the mucosal villous architecture in all cases, along with persistent symptoms and abnormal antibody levels.

In contrast, the gluten-free group showed less damage, generally Marsh I–II, a retreat of symptoms, reduced antibody levels along with reductions in mucosal inflammation similar to controls (Marsh III).

The team concluded that a gluten-free diet provides similar benefits for gluten intolerant patients without clinical celiac disease as for those with celiac disease, that the diagnostic criteria for celiac disease warrant re-evaluation,  that the presence of endomysial antibodies without mucosal damage should be included in chain of genetic gluten intolerance, and and finally that such cases merit treatment with gluten-free diet.


GASTROENTEROLOGY 2009;136:816–823

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4 Responses:

 
Mrs Anne Brinicombe
Rating: ratingfullratingfullratingfullratingfullratingfull Unrated
said this on
20 Apr 2009 11:28:09 PM PDT
I am delighted with these findings. I realized that I was gluten intolerant or coeliac 10 years ago and put myself on a gluten free diet. I since realized I should have waited for a diagnosis. My consultant says I can't have a diagnosis without making myself ill again. He suggests I just persist with the diet. However, without a diagnosis I have no access to the benefits. After inadvertently eating gluten on holiday I have several symptoms and my dermatitis has returned. I will be very interested to follow your research and would be happy to be part of a research group.

 
Kristy
Rating: ratingfullratingfullratingemptyratingemptyratingempty Unrated
said this on
16 Jan 2013 10:23:35 AM PDT
No citations...too bad. Can't seem to find related article from team of researchers you mentioned either. Not highly credible without citations (you know that!)

 
Gryphon
( Author)
said this on
16 Jan 2013 3:33:27 PM PDT
The study is cited as a source at the end of the article. Here is a link to it, since you seem to have trouble finding it: http://www.gastrojournal.org/article/S0016-5085(08)02070-2/abstract

 
crystal

said this on
05 Jun 2014 10:30:57 AM PDT
If you have had extensive GI surgery to include partial gastrectomy, how would gluten free benefit your digestion, etc?




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George, i am sorry that you are not feeling well! ?? I am not a doctor, but just trying out drugs to stop your symptoms just seems like a band aid approach. It sounds like he suspects IBS which is really, in my opinion, "I be stumped". Has inflammatory bowel disorder (IBD) (more lovely autoimmune disorders) been ruled out? This includes both Crohn's and Colitis. My niece was diagnosed with Crohn's finally with a pill camera after all other tests were given. The damage was not within reach of any scope. I am just throwing out suggestions. Hopefully, you and your doctor will figure it out soon!

Celiac disease is an autoimmune disease that happens to have a known trigger -- gluten. Flare-ups develop (antibodies) causing damage. Not just in the small intestine, but systemically. One gluten exposure can cause antibodies to increase for days or months! Antibodies are being measured during the celiac blood tests. If there is no gluten exposure, there will be no antibodies. These antibodies can come down in some people in as little as two weeks. Recommendations require gluten 2 to 4 weeks daily for the biopsies taken via endoscopy in order to be sure to catch damage, but 8 to 12 weeks for the blood tests. The endoscopy is considered the "gold standard" in helping to diagnose celiac disease, but there are other things that can damage the small intestine. So, the blood test helps solidify the diagnosis. So, if you want a good result on your endoscopy, you need to be eating gluten daily for two week prior at a minimum. I know it is tough and you are feeling sick. Wish there was a better way to catch active celiac disease.

Hi everyone, Just an update to my situation. I had thought that I might be getting better since I started adding gluten-free grain back into my diet but I was wrong. It seems that the Methscopalamine Bromide just delayed the effects, didn't stop them. I had to stop taking it because one of the side effects is to stop sweating, which I did. There were times when I felt hot and almost couldn't catch my breath. Anyway, my doc put me on Viberzi instead. I took 3 doses, 1 Tuesday evening and then 1 Wednesday morning and then again Wednesday evening. Each time I took 1, it seemed that about half an hour later I would develop severe abdominal cramping, pain in my neck, shoulders and upper back and a feeling like my insides were on fire. My face felt like it was hot and tingling. It wasn't warm to the touch but felt like it to me. Worse of all is it didn't work anyway, I still had diarrhea. I stopped taking Viberzi after reading the precautions pamphlet which said, "stop taking Viberzi and tell your doctor if you have abdominal cramping, pain which radiates to your shoulders or upper back." Go figure. Anyway, today is 3 weeks straight of diarrhea and still no diagnosis and not sure what he's going to want to do next. George

I'm still really new to all this but is it common to have trouble with sleep? I swear since my symptoms got really bad a few months ago I can't get 1 good nights sleep, like a 5 hour stretch is doing real good. Wake up at 3am wide awake almost every night. Told my doctor and they've recommended melatonin, that doesn't work. Tried chamomile and lavender tea, no help. Tried zzquil, that will knock me out but maybe for like an extra hour then I'm really drowsy the next morning from it. I don't know what to do.

I have 2 copies of DQ9. One from each parent.