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Recent Developments in Pediatric Research, Dr. Philip Butzner,
-----------------------------------------  University of Calgary

Dr. Butzner noted that Celiac Disease (CD) is a permanent intolerance
to the ingestion of gluten characterized by inflammatory enteropathy
and malabsorption (villus atrophy, crypt hyperplasia, and increased
intraepithelial lymphocytes).

When Dr. Butzner started in 1981, tools for the diagnosis of CD were
limited to the biopsy.  The classic case of CD that was seen in the
early 80's was the wasting child who typically presented as having a
bad growth curve and usually had the typical flat villi biopsy.  Then
in the mid-80's in Europe and about 1995 in the U.S., serological
screening became available.  However, the gold standard for diagnosing
CD remains the small intestine biopsy.

Dr. Butzner discussed CD and Type I Diabetes in children.  Blood
screening, particularly IGA-EMA (anti-endomysial antibody),
demonstrated an association between CD and IDDM (Insulin Dependant
Diabetes Melititus, also called Type I Diabetes) of 1 to 4% whereas it
was only 0.02% in the general population.  There are, of course,
significant risks if diabetes and CD are left untreated, such as
delayed puberty, growth failure, osteopenia, osteomalacia, anemia
and/or gastrointestinal lymphoma.  However, an adult study found that
the metabolic control of the diabetes was improved in celiac patients
on a gluten-free (GF) diet (Shannon et al, 1982).

Dr. Butzner conducted a study to assess IGA-EMA as a screening test
for CD in children with IDDM.  For the study, blood samples from 236
known diabetics (1-18 years in age) were tested for total IGA and
IGA-EMA by immunofluorescence.  Of the 17 that had positive blood
tests, 12 were subsequently diagnosed with CD.  This is a prevalence
of about 5%, which is far higher than the prevalence of CD in the
general population.  These results suggest that all Type I diabetic
children should be screened for CD.

At Dr. Butzner's clinic they utilize the capsular intestinal biopsy
technique.  One of his observations is that when taking a biopsy,
MULTIPLE biopsy sources are needed to ensure a true reading.
Permeability testing did not prove helpful.  Better standards for
testing are needed.

Next Dr. Butzner spoke on oats.  First, some facts:

  * Avenin makes up 15% of the protein in oats, whereas gliadin makes
    up 50% of the protein in wheat.

  * Oats and rice are in the same subfamily as wheat, rye, and
    barley, but not in the same family

Dr. Butzner noted that previous studies on oats were short term and
did not involve children.  These studies showed no relapse.  All used
pure (uncontaminated) oats.

Based on his clinical experience that 40% of celiac children cheat on
their GF diets, Dr. Butzner conducted a study on celiac children and
oats.  The aim of the study was to determine the safety of adding a
moderate amount of commercially-available oats to the diet of celiac
children.  He stated that he had contacted all the Canadian sources of
oats and could not find any GF oats for his study.  Quaker Oats
provided their standard product for the study.  14 children, aged 8 to
16, with normal growth and no abnormalities, consumed oats 25 days per
month.  They were given 1 gram (gm) of oats for each kilogram (kg) of
body weight per day, up to a maximum of 50 gm/day.  The clinic
followed up by telephone at 1, 3, 6, and 9 months and with blood
testing and biopsy at one year.  None of the children displayed any
symptoms during the year.  After one year, one child had elevated
blood readings but a normal biopsy.  Also, after one year, one child
who displayed blunted villi was determined to have been consuming
other grains.  When the child returned to oats only, the blood
antibodies returned to normal in 3 months.

Dr. Butzner noted several conclusions from his research:

  1. Commercially available oats are OK for celiac children to consume
     daily for one year.

  2. IGA-EMA testing is a sensitive method of monitoring dietary
     compliance.

  3. The quality of antibody testing must be improved so as to be
     equivalent anywhere.

  4. More food testing is needed and standards have to be established.

  5. A safe source of oats should be available.  To date there have
     been no failures in two adult CD studies, two adult dermatitis
     herpetiformis studies and now two children CD studies with oats.

[Editor's note:  Our group remains unconvinced that oats are safe for
celiacs.  Two studies presented at the "Seventh International
Symposium on Coeliac Disease" held in Tampere, Finland in 1996 present
a different picture:

  * A Finland study looked at twelve adult dermatitis herpetiformis
    (DH) patients who began eating oats.  After three months, five of
    them developed a slight rash on the knees, elbows, or scalp.<1>

  * A study in Italy took biopsy samples from treated celiacs and
    cultured them for 24 hours either alone or in the presence of
    wheat gliadin or oat prolamines.  After that time CD25+
    lymphocytes were counted.  It was found that in the presence of
    wheat or oat prolamines there were significantly more of these
    lymphocytes.  The study concludes that these results suggest oat
    prolamines are able to activate a T-cell mediated mucosal immune
    system response in the jejunum of celiacs.  In other words, these
    results represent a warning against adding oats to the diet of a
    celiac.<2>]