Wheat-starch-based gluten-free products in the treatment of newly detected coeliac disease: prospective and randomized study.
BACKGROUND
The safety of wheat-starch-based gluten-free products in the treatment of coeliac disease is debatable. Prospective studies are lacking.


OBJECTIVE
: To compare the clinical, histological and serological response to a wheat-starch-based or natural gluten-free diet in patients with newly detected coeliac disease.


METHODS
Fifty-seven consecutive adults with untreated coeliac disease were randomized to a wheat-starch-based or natural gluten-free diet. Clinical response, small bowel mucosal morphology, CD3+, alphabeta+ and gammadelta+ intra-epithelial lymphocytes, mucosal human leucocyte antigen-DR expression and serum endomysial, transglutaminase and gliadin antibodies were investigated before and 12 months after the introduction of the gluten-free diet. Quality of life measurements were performed by standardized questionnaires and the bone mineral density was analysed.


RESULTS
In both groups, abdominal symptoms were alleviated equally by a strict diet. There were no differences between the groups in mucosal morphology, the density of intra-epithelial lymphocytes, serum antibodies, bone mineral density or quality of life tests at the end of the study. Four patients on a natural gluten-free diet and two on a wheat-starch-based gluten-free diet had dietary lapses; as a result, inadequate mucosal, serological and clinical recovery was observed.


CONCLUSIONS
The dietary response to a wheat-starch-based gluten-free diet was as good as that to a natural gluten-free diet in patients with newly detected coeliac disease.
Peräaho
M
M
Department of Medicine, Tampere University Hospital, Tampere, Finland.
Kaukinen
K
K
Paasikivi
K
K
Sievänen
H
H
Lohiniemi
S
S
Mäki
M
M
Collin
P
P
D000328:Adult; D000368:Aged; D015519:Bone Density; D002446:Celiac Disease / Q000097:blood / Q000178:diet therapy* / Q000473:pathology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006304:Health Status; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D013213:Starch / Q000008:administration & dosage*; D014908:Triticum
D007070:Immunoglobulin A; D013213:Starch