Gluten tolerance in adult patients with celiac disease 20 years after diagnosis?
OBJECTIVE
Celiac disease (CD) is believed to be a permanent intolerance to gluten. A number of patients, however, discontinue the gluten-free diet (GFD) without developing symptoms or signs. The aim of our study was to investigate whether CD patients are capable of developing tolerance to gluten.


METHODS
All 77 adult patients from our hospital known to have biopsy-proven CD for more than 10 years were invited to participate. We investigated symptoms, gluten consumption, antibodies for CD and other autoimmunity, human leukocyte antigen (HLA)-typing, bone mineral density, and performed small bowel biopsies. Tolerance was defined as no immunological or histological signs of CD while consuming gluten.


RESULTS
Sixty-six patients accepted participation, but after review of the diagnostic biopsies 53 were found to have true CD. Twenty-three percent of patients had a gluten-containing diet, 15% admitted gluten transgression and 62% followed the GFD. Patients on a GFD had significantly more osteoporosis. Normal small bowel mucosa was found in four of eight on gluten-containing diet and in four of four with gluten transgression. Two patients were considered to have developed tolerance to gluten. One of them was HLA-DQ2/DQ8 negative.


CONCLUSIONS
Development of tolerance to gluten seems possible in some patients with CD. Further follow-up will show whether this tolerance is permanent or only a long-term return to latency. This feature may be associated with genetic characteristics, especially with HLA genotypes that differ from DQ2 or DQ8. More insight into the mechanisms of the development of gluten tolerance may help to distinguish those CD patients that might not require life-long GFD.
Hopman
Erica G D
EG
Department of Dietetics and Nutrition, Leiden University Medical Center, Leiden, The Netherlands. G.D.Hopman@lumc.nl
von Blomberg
Mary E
ME
Batstra
Manou R
MR
Morreau
Hans
H
Dekker
Friedo W
FW
Koning
Frits
F
Lamers
Cor B H W
CB
Mearin
Maria Luisa
ML
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood; D015519:Bone Density; D002446:Celiac Disease / Q000178:diet therapy* / Q000235:genetics / Q000276:immunology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005983:Glutens / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D006683:HLA-DQ Antigens / Q000097:blood; D006650:Histocompatibility Testing; D006801:Humans; D007108:Immune Tolerance; D007413:Intestinal Mucosa / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012720:Severity of Illness Index
D001323:Autoantibodies; D006683:HLA-DQ Antigens; C053186:HLA-DQ2 antigen; D005983:Glutens