Wheat starch-containing gluten-free flour products in the treatment of coeliac disease and dermatitis herpetiformis. A long-term follow-up study.
BACKGROUND
We investigated whether wheat starch-based gluten-free products are safe in the treatment of gluten intolerance.


METHODS
The study involved 41 children and adults with coeliac disease and 11 adults with dermatitis herpetiformis adhering to a gluten-free diet for 8 years on average. Thirty-five newly diagnosed coeliac patients at diagnosis and 6 to 24 months after the start of a gluten-free diet and 27 non-coeliac patients with dyspepsia were investigated for comparison. Daily dietary gluten and wheat starch intake were calculated. Small-bowel mucosal villous architecture, CD3+, alphabeta+, and gammadelta+ intraepithelial lymphocytes, mucosal HLA-DR expression, and serum endomysial, reticulin, and gliadin antibodies were investigated.


RESULTS
Forty of 52 long-term-treated patients adhered to a strict wheat starch-based diet and 6 to a strict naturally gluten-free diet; 6 patients had dietary lapses. In the 46 patients on a strict diet the villous architecture, enterocyte height, and density of alphabeta+ intraepithelial lymphocytes were similar to those in non-coeliac subjects and better than in short-term-treated coeliac patients. The density of gammadelta(+)cells was higher, but they seemed to decrease over time with the gluten-free diet. Wheat starch-based gluten-free flour products did not cause aberrant upregulation of mucosal HLA-DR. The mucosal integrity was not dependent on the daily intake of wheat starch in all patients on a strict diet, whereas two of the six patients with dietary lapses had villous atrophy and positive serology.


CONCLUSIONS
Wheat starch-based gluten-free flour products were not harmful in the treatment of coeliac disease and dermatitis herpetiformis.
Kaukinen
K
K
Dept. of Medicine, Tampere University Hospital, Finland.
Collin
P
P
Holm
K
K
Rantala
I
I
Vuolteenaho
N
N
Reunala
T
T
Mäki
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers; D002446:Celiac Disease / Q000178:diet therapy* / Q000378:metabolism / Q000473:pathology; D002648:Child; D003874:Dermatitis Herpetiformis / Q000178:diet therapy* / Q000378:metabolism / Q000473:pathology; D004032:Diet; D005260:Female; D005433:Flour; D005500:Follow-Up Studies; D005983:Glutens; D006801:Humans; D007249:Inflammation; D007413:Intestinal Mucosa / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013213:Starch; D014908:Triticum
D015415:Biomarkers; D005983:Glutens; D013213:Starch