Low-dose gluten challenge in celiac sprue: malabsorptive and antibody responses.
OBJECTIVE
Undiagnosed patients with symptoms of celiac sprue often present to physicians after establishing dietary gluten exclusion. Although they must resume a gluten-containing diet for evaluation, there are no guidelines regarding duration of the gluten challenge, gluten dose, or monitoring parameters. We investigated the effects of a short-term gluten challenge in asymptomatic treated adult celiac patients on intestinal absorption and celiac antibody tests.


METHODS
Eight adult asymptomatic celiac patients consumed either 5 or 10 g of partially hydrolyzed gluten per day in an orange juice mixture for 21 days while maintaining their usual gluten-free diet. A symptom questionnaire, serum antibodies (antigliadin immunoglobulin [Ig]A and antitransglutaminase IgA and IgG), D-xylose urine excretion test, and 72-hour quantitative fecal fat test were monitored.


RESULTS
Two patients (25%) had at least 1 abnormal celiac antibody test at baseline. There was no increase in antibodies during gluten exposure compared with baseline for any of the patients (P > .05). At baseline, 1 patient had abnormal urine xylose excretion, and 3 patients had abnormal fecal fat values. At day 15 of gluten challenge, all patients had reduced xylose absorption compared with baseline (P = .0019), and 5 of 8 participants (63%) reduced their xylose excretion to the abnormal range. Seven of 8 patients (88%) had increased fecal fat excretion at day 15 (P = .026), and 6 of these (75%) had steatorrhea by day 15.


CONCLUSIONS
Short-term gluten challenge in asymptomatic adult celiac patients produces carbohydrate and fat malabsorption but does not increase transglutaminase and antigliadin antibody titers.
Pyle
Gail G
GG
Celiac Sprue Research Foundation, Palo Alto, California 94304-1193, USA.
Paaso
Brian
B
Anderson
Barbara E
BE
Allen
Diane
D
Marti
Thomas
T
Khosla
Chaitan
C
Gray
Gary M
GM
D000368:Aged; D000917:Antibody Formation / Q000187:drug effects; D002446:Celiac Disease / Q000097:blood / Q000276:immunology*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005983:Glutens / Q000008:administration & dosage* / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D007074:Immunoglobulin G / Q000097:blood*; D007408:Intestinal Absorption / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D011503:Transglutaminases / Q000276:immunology
D007070:Immunoglobulin A; D007074:Immunoglobulin G; D005983:Glutens; D011503:Transglutaminases