title: Limitations of xylose tolerance test as a screening procedure in childhood coeliac disease.
abstract: The usefulness of the xylose tolerance test as a screening procedure for coeliac disease has been reassessed in 54 children with suspected coeliac disease. 5- and 24-hour urinary excretion rates of xylose were of no value in discriminating between patients with and without coeliac disease; similarly, the 3-hour blood xylose concentration was nondiscriminatory. Three (15-8%) patients with subtotal villous atrophy and 8 (61-5%) with partial villous atrophy due to coeliac disease had one-hour blood xylose values which fell within the normal range. The effect of withdrawal or reintroduction of dietary gluten on sequential one-hour blood xylose levels was variable and generally unhelpful in predicting those patients who developed gluten-induced mucosal changes. The results of the present study emphasize the serious limitations of the xylose tolerance test as a screening procedure in childhood coeliac disease. It is recommended that the use of the urinary xylose test should be abandoned in the paediatric population. A normal one-hour blood xylose value does not exclude a diagnosis of coeliac disease even in young children who have never received a gluten-free diet. A clinical suspicion of coeliac disease remains the most important single factor in deciding whether to preform a jejunal biopsy.
mesh_terms: D000293:Adolescent; D001284:Atrophy / Q000209:etiology; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D004032:Diet; D005215:Fasting; D005983:Glutens; D006801:Humans; D007223:Infant; D007413:Intestinal Mucosa / Q000473:pathology; D007583:Jejunum / Q000473:pathology; D008722:Methods; D014994:Xylose / Q000097:blood / Q000652:urine
chemical_list: D005983:Glutens; D014994:Xylose