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Gluten challenge in treated coeliac disease
Insights
Gluten challenge confirmed coeliac disease in 78% of children previously diagnosed. A normal intestinal biopsy after a 3-month gluten challenge effectively excludes coeliac disease in children.
Area of Science:
- Pediatrics
- Gastroenterology
- Immunology
Background:
- Coeliac disease diagnosis requires confirmation, especially after prolonged gluten-free diets.
- Re-evaluation of previous diagnoses is crucial for accurate long-term management.
Purpose of the Study:
- To investigate the diagnostic accuracy of gluten challenge in children with a history of coeliac disease.
- To determine the reliability of intestinal biopsies following gluten reintroduction.
Main Methods:
- Thirty-two children with prior coeliac disease diagnosis underwent a gluten challenge (10g/day for 3 months).
- Small intestinal biopsies were performed pre- and post-challenge.
- Light microscopy and morphometric techniques assessed biopsy changes.
Main Results:
- Coeliac disease was confirmed in 25 (78%) of the 32 children.
- In 7 children, continued challenge for 2 years resulted in normal biopsies, excluding coeliac disease.
- Clinical symptoms and blood markers were unreliable indicators of gluten-induced enteropathy.
Conclusions:
- Gluten challenge combined with intestinal biopsy is essential for diagnosing coeliac disease.
- A normal biopsy after a 3-month gluten challenge reliably excludes coeliac disease in children.
Abstract:
Thirty-two children with a past diagnosis of coeliac disease were reinvestigated by means of gluten challenge. They had received a gluten-free diet for a mean period of 6-5 years (range 0-25-11-0) before gluten challenge, and had a mean age of 9-9 years (range 3-0-15-3) at the onset of challenge. Small intestinal biopsies were performed before and after the gluten challenge (at least 10 g natural gluten per day for 3 months in the majority) and, as judged by light microscopy and morphometric techniques, coeliac disease was confirmed in 25 (78%) of the 32 patients; challenge was continued in the remaining 7 for a total period of 2 years when biopsies were repeated in 6 children and all were normal. Serum and RBC folate, serum iron, Hb level, and clinical symptoms were unpredictable variables in identifying children who developed gluten-induced enteropathies. The social and emotional effects of gluten challenge are discussed. The results highlight the importance of gluten challenge and intestinal biopsy in the diagnosis of coeliac disease and strongly suggest that a normal biopsy after a 3-month gluten challenge (as described above) excludes coeliac disease.