Wheat Starch-containing Gluten-free Flour Products in the Treatment of Coeliac Disease and Dermatitis Herpetiformis. A Long-term Follow-up Study.

Scand J Gastroenterol 1999 Feb;34(2):163-9
PMID: 10192194, UI: 99206412
Authors: Kaukinen K, Collin P, Holm K, Rantala I, Vuolteenaho N, Reunala T, Maki M
Dept. of Medicine, Tampere University Hospital, Finland.

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

BACKGROUND: We investigated whether wheat starch-based gluten-free products are safe in the treatment of gluten intolerance.

METHODS: The study involved 41 children and adults with coeliac disease and 11 adults with dermatitis herpetiformis adhering to a gluten-free diet for 8 years on average. Thirty-five newly diagnosed coeliac patients at diagnosis and 6 to 24 months after the start of a gluten-free diet and 27 non-coeliac patients with dyspepsia were investigated for comparison. Daily dietary gluten and wheat starch intake were calculated. Small bowel mucosal villous architecture, celiac disease3+, alphabeta+, and gammadelta+ intraepithelial lymphocytes, mucosal HLA-DR expression, and serum endomysial, reticulin, and gliadin antibodies were investigated. RESULTS: Forty of 52 long-term-treated patients adhered to a strict wheat starch-based diet and 6 to a strict naturally gluten-free diet; 6 patients had dietary lapses. In the 46 patients on a strict diet the villous architecture, enterocyte height, and density of alphabeta+ intraepithelial lymphocytes were similar to those in non-coeliac subjects and better than in short-term-treated coeliac patients. The density of gammadelta(+)cells was higher, but they seemed to decrease over time with the gluten-free diet. Wheat starch-based gluten-free flour products did not cause aberrant upregulation of mucosal HLA-DR. The mucosal integrity was not dependent on the daily intake of wheat starch in all patients on a strict diet, whereas two of the six patients with dietary lapses had villous atrophy and positive serology.

CONCLUSION: Wheat starch-based gluten-free flour products were not harmful in the treatment of coeliac disease and dermatitis herpetiformis.