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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) 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.

Alimentary Pharmacology & Therapeutics, Volume 19 Issue 12 Page 1277 - June 2004 Celiac.com 06/28/2004 – According to celiac disease researchers gluten contamination in gluten-free products cannot be totally avoided. With this in mind they set out to determine the safe threshold of gluten in the diets of those with celiac disease. To determine this level they measured the gluten content of 59 naturally gluten-free and 24 Codex quality wheat starch-based gluten-free products using the enzyme-linked immunosorbent assay test. The daily intake of flours was calculated in 76 adults on gluten-free diets and was then compared with their biopsies (mucosal histology). The researchers found that 13 of the 59 naturally gluten-free products and 11 of 24 Codex quality wheat starch-based gluten-free products contained gluten in the amount of 20 to 200 ppm (=mg/kg). The average flour intake for the group was 80g, and this ranged between 10g at the low end, and 300g on the high end. The researchers conclude that the threshold for gluten in the diets of those with celiac disease can safely be set at 100 ppm. Even those in the study who consumed flour at the high end--300g per day with a gluten level of 100 ppm--only consumed 30mg of gluten per day. The researchers determined that this level was safe when correlated to their histology in both clinical and challenge studies. Last, this level can be achieved by the food industry, will not make the diet too cumbersome, and will have the additional benefit of encouraging additional food companies to get into the gluten-free food market.

European Journal of Clinical Nutrition (2003) 57, 163-169. doi:10.1038/sj.ejcn.1601525 S Størsrud1,a,b, M Olsson2,b, R Arvidsson Lenner1,b, L Ã… Nilsson3,b, O Nilsson4,b and A Kilander2,b 1) Department of Clinical Nutrition, Sahlgrenska University Hospital, Gothenburg, Sweden 2) Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden 3) Department of Medical Microbiology and Immunology, Sahlgrenska University Hospital, Gothenburg, Sweden 4) Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden Abstract: Celiac.com 3/14/2003 - Objective: The aim of the present study was to investigate whether adult patients with coeliac disease in remission could include large amounts of oats in their daily gluten-free diet for an extended period of time without adverse effects. Design, subjects and methods: Twenty adult coeliac patients in remission included large amounts of uncontaminated rolled oats in their daily diet for a prolonged period. The examinations, performed four times during the study period, included small bowel endoscopy with biopsies, blood samples (nutritional status, serological analysis), height and body weight, gastrointestinal symptoms and dietary records. Gastrointestinal symptoms and diet were also investigated through unannounced telephone interviews once a month during the study period. Results: No adverse effects of a large intake of oats were seen in small bowel histology, serology nor in nutritional status in the 15 subjects who completed the whole study period. Two of the subjects dropped out because of gastrointestinal symptoms and three for non-medical reasons. The median intake of oats was 93 g/day and the compliance to the oat diet was found to be good. Examinations of the patients after drop-out did not show any deterioration in small bowel histology or nutritional status nor raised levels of antibodies. Conclusion: Results from this study indicate that adult patients with coeliac disease in remission can include large amounts of controlled wheat-free rolled oats for an extended period of time without adverse effects. Sponsorship: This study was supported by Vårdalstiftelsen, Kommunalförbundet Västra Götaland, Stiftelsen Cerealia FoU, and the Swedish Nutrition Foundation. Kungsörnen AB supported the study with rolled oats.