<<Disclaimer: Verify this information before applying it to your situation.>> 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>]