Gluten challenge in patients with celiac disease: evaluation of alpha 1-antitrypsin clearance.
Our aim in this study was to monitor changes of the intestinal structure by alpha 1-antitrypsin clearance (alpha 1-ATCL) in order to offer an alternative to the gluten challenge biopsy. In addition, we evaluated the possibility of reducing the time of gluten challenge. Twelve patients had a presumptive diagnosis of celiac disease based on clinical and histological grounds. They were studied when the jejunal histology was normal after gluten-free diet and an alpha 1-ATCL was normal. The gluten was introduced by returning to a normal diet. The challenge lasted 4 wk. We measured alpha 1-ATCL at the end of the 1st and 4th wk, and a new jejunal biopsy was obtained at the end of the 4th wk. By wk 1, alpha 1-ATCL was abnormal in 11 patients but normal in one. By wk 4, alpha 1-ATCL was abnormal in 10 patients and still normal in one. The post-challenge biopsies showed atrophy in 11 and was normal only in the patient with normal alpha 1-ATCL at wk 1 and 4. One patient with abnormal alpha 1-ATCL had to stop the challenge at the first week. The patient with normal clearance at wk 1 and 4 and normal biopsy at wk 4 had abnormal results at 6 months. These data support our hypothesis that alpha 1-ATCL can be used as evidence of gluten toxicity after gluten challenge, and that this test can be abnormal as early as 1 wk after gluten is reintroduced.
Bai
J C
JC
Small Bowel Section, Hospital Nacional de Gastroenterologia, Dr. Carlos B. Udaondo, Buenos Aires, Argentina.
Sambuelli
A
A
Sugai
E
E
Pedreira
S
S
Kogan
Z
Z
Boerr
L A
LA
Martinez
C
C
Maurino
E C
EC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000906:Antibodies / Q000032:analysis; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis / Q000378:metabolism* / Q000473:pathology; D005243:Feces; D005260:Female; D005903:Gliadin; D005983:Glutens; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D000515:alpha 1-Antitrypsin / Q000378:metabolism*
D000906:Antibodies; D000515:alpha 1-Antitrypsin; D005983:Glutens; D005903:Gliadin