Gluten tolerance in adult patients with celiac disease 20 years after diagnosis?

Department of Dietetics and Nutrition, Leiden University Medical Center, Leiden, The Netherlands.
European Journal of Gastroenterology & Hepatology (Impact Factor: 2.15). 06/2008; 20(5):423-9. DOI: 10.1097/MEG.0b013e3282f4de6e
Source: PubMed

ABSTRACT Celiac disease (CD) is believed to be a permanent intolerance to gluten. A number of patients, however, discontinue the gluten-free diet (GFD) without developing symptoms or signs. The aim of our study was to investigate whether CD patients are capable of developing tolerance to gluten.
All 77 adult patients from our hospital known to have biopsy-proven CD for more than 10 years were invited to participate. We investigated symptoms, gluten consumption, antibodies for CD and other autoimmunity, human leukocyte antigen (HLA)-typing, bone mineral density, and performed small bowel biopsies. Tolerance was defined as no immunological or histological signs of CD while consuming gluten.
Sixty-six patients accepted participation, but after review of the diagnostic biopsies 53 were found to have true CD. Twenty-three percent of patients had a gluten-containing diet, 15% admitted gluten transgression and 62% followed the GFD. Patients on a GFD had significantly more osteoporosis. Normal small bowel mucosa was found in four of eight on gluten-containing diet and in four of four with gluten transgression. Two patients were considered to have developed tolerance to gluten. One of them was HLA-DQ2/DQ8 negative.
Development of tolerance to gluten seems possible in some patients with CD. Further follow-up will show whether this tolerance is permanent or only a long-term return to latency. This feature may be associated with genetic characteristics, especially with HLA genotypes that differ from DQ2 or DQ8. More insight into the mechanisms of the development of gluten tolerance may help to distinguish those CD patients that might not require life-long GFD.

Download full-text


Available from: Friedo W. Dekker, Jun 28, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Celiac disease is an immune‐mediated disease, triggered in genetically susceptible individuals by ingested gluten from wheat, rye, barley, and other closely related cereal grains. The only treatment for celiac disease is a strict gluten‐free diet for life. This paper presents a systematic review of the scientific literature on the safety of pure oats for individuals with celiac disease, which historically has been subject to debate.Limitations identified within the scientific database include: limited data on long‐term consumption, limited numbers of participants in challenge studies, and limited reporting about the reasons for withdrawals from study protocols. Furthermore, some evidence suggests that a small number of individuals with celiac disease may be intolerant to pure oats and some evidence from in vitro studies suggests that an immunological response to oat avenins can occur in the absence of clinical manifestations of celiac disease as well as suggesting that oat cultivars vary in toxicity.Based on the majority of the evidence provided in the scientific database, and despite the limitations, Health Canada and the Canadian Celiac Association (CCA) concluded that the majority of people with celiac disease can tolerate moderate amounts of pure oats. The incorporation of oats into a gluten‐free diet provides high fiber and vitamin B content, increased palatability, and beneficial effects on cardiovascular health. However, it is recommended that individuals with celiac disease should have both initial and long‐term assessments by a health professional when introducing pure oats into a gluten‐free diet.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Celiac disease is an intolerance to dietary gluten in genetically predisposed individuals, leading to alterations of the small bowel mucosa. The treatment consists of a life-long, gluten-free diet. The aims of this thesis were to measure some of the environmental factors considered to play a role in the prevention of celiac disease. For that purpose breast milk was studied on the presence of glutenpeptides and a food frequency questionnaire was developed and validated to quantify gluten intake in young infants. Furthermore, the current treatment at different ages and the ability to develop gluten tolerance were studied. It became clear that the nutrient intake of adolescents on a gluten-free diet can be ameliorated, and that the rather new naturally gluten-free cereal tef is frequently used by Dutch celiac patients and a wide majority of them can consume tef without clinical symptoms. Therefore tef can be a valuable addition to their diet. Although celiac disease is considered to be a permanent condition, we made an attempt to find patients who have become tolerant to gluten. We found 2 of these exceptional patients and found that one of them had HLA-typing different from HLA-DQ2/DQ8, suggesting that genetic factors may play a role in the development of tolerance. The underlying mechanisms leading to prevention, disease development or tolerance to gluten are complex and need to be further studied.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Celiac disease (CD) is a multifactorial disease with a strong genetic association. It is caused by a T-cell-mediated immune response to wheat gluten. The treatment is a strict gluten-free diet (GFD). The purpose of this study was to investigate whether the naturally gluten-free cereal Eragrostis tef (tef) is associated with health problems when used by CD patients. In March 2006, all 7990 members of the Dutch Celiac Disease Society were invited to complete a questionnaire on tef use and the development of symptoms after tef consumption. Respondents and their family members willing to participate were sent an extended questionnaire on the use of commercially available tef products and on the character of their subsequent symptoms. Thirty-six percent responded to the first questionnaire of whom 53% consumed tef and 15% reported complaints. For the second questionnaire, out of the 1828 participants willing to complete it, 1545 had biopsy-proven CD (median duration GFD: 6.5 years (range: 0-66.5 years)). Of these, 66% used tef (median duration 1.4 years (range: 0.1-5 years)) and 17% reported symptoms after consumption. The percentage for symptoms was significantly lower than that in patients without tef consumption reporting on their regular GFD (17% versus 61%; p = 0.0001). Tef is frequently used by Dutch CD patients and a wide majority can consume tef without experiencing any clinical symptoms. CD patients using tef reported a significant reduction in symptoms, possibly related to a reduction in gluten intake or to an increase in fiber intake. Hence, tef can be a valuable addition to the GFD of CD patients.
    Scandinavian Journal of Gastroenterology 04/2008; 43(3):277-82. DOI:10.1080/00365520701714871 · 2.33 Impact Factor
Show more