SUMMARY BackgroundRefractory sprue with malabsorption carries a risk of lymphoma.

Clinically pertinent coeliac disease exists despite normal small-bowel mucosal villous architecture. Mucosal transglutaminase 2-specific IgA deposits can be utilized in detecting such patients with genetic gluten intolerance.

The oats-containing gluten-free diet caused more intestinal symptoms than the traditional diet. Mucosal integrity was not disturbed, but more inflammation was evident in the oats group. Oats provide an alternative in the gluten-free diet, but coeliac patients should be aware of the possible increase in intestinal symptoms.

Summary Background : The safety of wheat‐starch‐based gluten‐free products in the treatment of coeliac disease is debatable. Prospective studies are lacking. Aim : 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+, αβ+ and γδ+ 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.