Since the toxic fraction of cereal flour which damages the small bowel mucosa of patients with coeliac disease has not been fully defined in vivo, we studied the effect of intraduodenal infusions of different doses of unfractionated gliadin and of alpha-, beta-, gamma- and omega-gliadin subfractions on the morphology of multiple jejunal biopsies taken from two patients with treated coeliac disease. A dose-response study with increasing quantities of unfractionated gliadin in one coeliac patient showed that 1000 mg produced marked damaged in serial jejunal biopsies taken 2-3 h after commencing the infusion and that the changes had almost completely disappeared 72 h later. alpha-, beta-, gamma- and omega-gliadin were prepared, checked for purity and investigated for toxicity in two coeliac patients. After an intraduodenal challenge with 1000 mg of the four gliadin subfractions these were shown to have induced damage in the mucosa of jejunal biopsies taken 6 h later. These observations confirm the results of studies in vitro, which suggest that not only alpha-but beta-, gamma- and omega-gliadin are enterotoxic in coeliac disease.

organisms treated with co-trimoxazole suggests differences in the clinical activities of these drugs. Amoxycillin alone is limited in its activity against urinary pathogens owing to the frequent presence of /1-lactamases. Martinelli Evaluation of a gluten free product containing wheat gliadin in patients with coeliac diseaseIn coeliac disease a characteristic lesion of the mucosa of the upper small intestine results in malabsorption. Wheat, rye, barley, and possibly oats have been shown to be toxic to patients with coeliac disease. Gliadin, the ethanol soluble fraction of wheat flour, can be divided into 1, ,B, y, and c subfractions, each of which exacerbates coeliac disease.1-3 Normal bread contains about 1 25 g gliadin per standard 30 g slice. A radioimmunoassay for wheat gliadin showed that bread made from a nominally gluten free flour based on wheat starch contained up to 6-4 mg gliadin per 30 g slice,4 and the product was withdrawn. Juvela and Rite Diet gluten free bread mixes contain only 0 4 mg and 0-2 mg gliadin per 30 g slice respectively. Although such quantities of gliadin are less than those previously reported to be enterotoxic,3 we wanted to test the products in patients with coeliac disease. Patients, methods, and resultsWe studied seven well adult patients with histologically proved coeliac disease who had been receiving a gluten free diet for at least a year. They gave written informed consent and followed a gluten free diet without any commercial gluten free products for one week, when a jejunal biopsy specimen was taken with a Watson jejunal biopsy capsule. They continued the same diet but each day ate six slices of bread that they had baked from Juvela gluten free bread mix. A second jejunal biopsy specimen was taken after the second week.The biopsy specimens were fixed in formol saline and their dissecting microscopical appearances were assessed blind. Sections were stained with haematoxylin and eosin and assessed blind for the ratio of villus height to crypt depth, the height of epithelial surface cells, and the intraepithelial lymphocyte count. The mean (SD) of 10 observations for each variable was recorded.The table shows the dissecting microscopical appearances and morphometric measurements of the seven patients before and after challenge. There was no deterioration in the dissecting microscopical appearances of the biopsy specimens except in one patient (case 5) who had broad villi and ridges instead of leaves and villi. The results before and after challenge were: ratio of villus height to crypt depth 2-4 (0 7) v 2-0 (0O5); height of epithelial surface cells 36 (5) /.m v 33 (4) ltm; and intraepithelial lymphocytes 37 (3) v 36 (6) per 100 enterocytes. The fall in the ratio of villus height to crypt depth was significant at the 5%O level, but the other morphometric variables were not significantly different using a paired Student's t test. CommentGluten free products based on wheat starch have been shown to contain trace amounts of gliadin,4 which could be toxic. We have shown previou...

Medical Research Societyhyrlrnlysates t.han from t.hoi r equi vnlent eqiiimolar amino ncid mirt.rirefi, hilt infliience of fit.arter protein composition and hydrolysis method on ahsorption of different hydrolysates has not h e m examined. Tun en7,yme systems, o n e papain hanrd, the othei. a porrine ?ancreat.ir en7,yme nirt.iire were used to prepare partial en7.ymic hydrolyfiates of lactalk~umin (21, eep a1 hiimi n and casein/soy/lactal hiimin mixtiire. Mnleriilar weight profile of all hyrlrnlysates was .55 ,, < 500, 1 yk 5oo-2non. Normal nrrhjerts

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