title: Low-dose gluten challenge in celiac sprue: malabsorptive and antibody responses.
abstract: 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.
authors.affiliation: Celiac Sprue Research Foundation, Palo Alto, California 94304-1193, USA.
authors.forename: Gail G
authors.initials: GG
authors.lastname: Pyle
authors.forename: Brian
authors.initials: B
authors.lastname: Paaso
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Anderson
authors.forename: Diane
authors.initials: D
authors.lastname: Allen
authors.forename: Thomas
authors.initials: T
authors.lastname: Marti
authors.forename: Chaitan
authors.initials: C
authors.lastname: Khosla
authors.forename: Gary M
authors.initials: GM
authors.lastname: Gray
mesh_terms: 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
chemical_list: D007070:Immunoglobulin A; D007074:Immunoglobulin G; D005983:Glutens; D011503:Transglutaminases