Evaluation of a gluten free product containing wheat gliadin in patients with coeliac disease.

Abstract

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a nominally gluten free flour based on wheat starch contained up to 6-4 mg gliadin per 30 g slice,4 and the product was withdrawn.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...

The safe threshold for gluten contamination in gluten‐free products. Can trace amounts be accepted in the treatment of coeliac disease?

“…This ensures a wide variety of gluten-free products and does not jeopardize the treatment of coeliac disease with inconvenient restrictions. 7 8 Adults 2.5-5 g gluten daily, median (6 months) -Increase in IELs Catassi et al 6 10 Children 100 mg gliadin daily (4 weeks) Asymptomatic Dose-dependent decrease in Vh/CrD, increase in IELs 10 500 mg gliadin daily (4 weeks) Anorexia and pale stools in three Sturgess et al 26 4 Adults 1 g gliadin (4 h) -Decrease in Vh/CrD in 3/4, increase in IELs in all Srinivasan et al 27 2 Adults 500 mg gluten daily (6 weeks) -Decrease in Vh/CrD in two Laurin et al 28 1 24 Open challenge 7 (7) Adults 1 week Small-bowel biopsy No Ciclitira et al 25 Open challenge 10 (10) Adults 6 weeks Small-bowel biopsy Cr-EDTA excretion Abdominal symptoms in some Ejderhamn et al 11 Cross-sectional 11 (11) Adolescents 10 years on average…”

Celiac disease: understanding the gluten-free diet

“…The variable results obtained in different studies are-at least it part-due to the highly variable gluten sensitivity observed among celiac patients [67]. Ciclitira et al [68] showed that patients consuming 1.2-2.4 mg gluten/day during 1 week had already detectable histological changes in the small intestinal mucosa; yet, in another study using the same amount of gluten administered during 6 weeks, histological mucosal changes could not be demonstrated [68]. Kaukinen et al [69] showed that patients that consumed on average 34 mg gluten/day during 8 years did not develop measurable duodenal histological abnormalities, but individuals consuming 34 mg of gluten daily plus 1-2 g of gluten weekly did develop villous atrophy [69].…”

Wheat‐starch‐based gluten‐free products in the treatment of newly detected coeliac disease: prospective and randomized study

“…On the other hand, according to some studies, wheat‐starch‐based gluten‐free flours are well tolerated and cause no small bowel mucosal deterioration 10–13 . In some challenge studies, small bowel mucosal inflammation has appeared after the ingestion of 5 mg to 5 g of gluten, 14 , 15 whereas, in others, no significant mucosal changes have been observed 16–18 . Due to this discrepancy, controversy persists as to the safety of wheat‐starch‐based gluten‐free products: these have been used for over 30 years in the UK and Scandinavia, but their consumption is discouraged in the USA 19 …”