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        Ronal Hoggan cited a paper published in 1988 showing an incomplete
histological and functional recovery in adult patients with CD. I have no
doubt that the conclusion of this paper was correct that time. However, it
is important to emphasize that the authors did not have the opportunity to
check the sctrictness of diet by measuring the antibody titers or the in
vitro cell-mediated immune response to gluten in their patients. It is
well known that the immunological alterations return to the normal within
months. If they are still present it suggest gluten ingestion.
 
        If a found an incomplete recovery of intestinal structure and
function in children, all these patients had positive in vitro immune
response to gluten suggesting accidental gluten consumption.
 
        To clarify this question a new well designed study necessary,
which proves that the examined patients group do not ingest gluten.
 
        I agree with Dr. Guandalini and I believe in a complete
restoration of intestinal structure in patients on a really strict
gluten-free diet.
 
Karoly Horvath, M.D., Ph.D.
Baltimore