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New study: Low-dose gluten challenge in celiac sprue: malabsorptive and antibody responses.

This new small study suggests that short-term gluten challenges are not good at identifying coeliacs already on a gluten-free diet.  ie if after being on a gluten-free diet you eat gluten for 3 weeks you may get symptoms but not blood antibodies. Incidentally the tests mentioned that suggest they were having a reaction were stool tests.  

This was only a tiny sample, no biopsies were done to see what was happening in the gut, nor is it clear from the abstract below how long the patients had been on the diet: they were all diagnosed coeliacs so they may have been on it some time.  

However it is another indication that people seeking a diagnosis of CD should NOT try the diet (for any length of time) before testing. Also that results from postponed gluten challenges may be misleading.  This may be relevant for parents considering delaying for a few years a final diagnosis in a child.

Charlotte, Oxford, UK

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16206501&query_hl=1

Clin Gastroenterol Hepatol. 2005 Jul;3(7):679-86.

Low-dose gluten challenge in celiac sprue: malabsorptive and antibody responses.

Pyle GG, Paaso B, Anderson BE, Allen D, Marti T, Khosla C, Gray GM. Celiac Sprue Research Foundation, Palo Alto, California 94304-1193, USA.

BACKGROUND & AIMS: Undiagnosed patients with symptoms of celiac sprue often present to physicians after establishing dietary gluten exclusion. Although they must resume a gluten-containing diet for evaluation, there are no guidelines regarding duration of the gluten challenge, gluten dose, or monitoring parameters. We investigated the effects of a short-term gluten challenge in asymptomatic treated adult celiac patients on intestinal absorption and celiac antibody tests. METHODS: Eight adult asymptomatic celiac patients consumed either 5 or 10 g of partially hydrolyzed gluten per day in an orange juice mixture for 21 days while maintaining their usual gluten-free diet. A symptom questionnaire, serum antibodies (antigliadin immunoglobulin [Ig]A and antitransglutaminase IgA and IgG), D-xylose urine excretion test, and 72-hour quantitative fecal fat test were monitored. RESULTS: Two patients (25%) had at least 1 abnormal celiac antibody test at baseline. There was no increase in antibodies during gluten exposure compared with baseline for any of the patients (P > .05). At baseline, 1 patient had abnormal urine xylose excretion, and 3 patients had abnormal fecal fat values. At day 15 of gluten challenge, all patients had reduced xylose absorption compared with baseline (P = .0019), and 5 of 8 participants (63%) reduced their xylose excretion to the abnormal range. Seven of 8 patients (88%) had increased fecal fat excretion at day 15 (P = .026), and 6 of these (75%) had steatorrhea by day 15. CONCLUSIONS: Short-term gluten challenge in asymptomatic adult celiac patients produces carbohydrate and fat malabsorption but does not increase transglutaminase and antigliadin antibody titers.

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