Small-Bowel Mucosa in Asymptomatic Children With Celiac Disease

Abstract

Even though children with celiac disease may appear to be progressing satisfactorily while taking gluten-free diets, dietary lapses and persisting mucosal abnormalities are common. Of 32 children with celiac disease proven by biopsy only ten kept regularly to their diet, and 11 continued to ingest gluten regularly. Despite satisfactory clinical progress, intestinal biopsy specimens obtained after at least one year of a gluten-free diet were markedly abnormal in eight and were normal in only 14 children. Laboratory criteria also failed to detect those with persisting mucosal abnormalities. The only way to ensure that the small-bowel mucosa returns to normal and remains so is by intestinal biopsy.

IgA Antigliadin Antibodies and Persistence of Jejunal Lesions in Adult Coeliac Disease

“…assessment and this is supported by the ob servation that 7 poorly complying patients with improvement of jejunal lesions were IgA AGA-negative. These patients, however, admitted some lapses from their diet, and this is in keeping with the report that adult coeliac patients can tolerate small quantities of gluten without morphological change and without initiating a significant IgA AGA re sponse [17], Previous attempts by other workers [ 18] failed to predict the status of the jejunal mucosa using noninvasive laboratory crite ria and concluded that, although dietary as sessment correlated more accurately with je junal mucosal findings than any of the pa rameters they measured, intestinal biopsy re mained the best means of determining the positive effect of GFD. We do agree with this view but our data show that, in coeliacs being IgA AGA-positive when untreated, the persistence of these antibodies after GFD is always predictive of the persistence of severe jejunal lesions.…”

Parents' understanding of coeliac disease and diet.

“…(23); (5) is it a life long disease? (3); (6) substance that should be avoided (41); (7) in which flours is gluten present? (27); (8) gluten is a constituent of fat, carbohydrate, or protein?…”

Adherence to Gluten-Free Diet and Serum Antigliadin Antibodies in Celiac Disease

“…On the other hand, a considerable number of our patients, who had variable gluten intakes, failed to develop a specific humoral re sponse. The dietary assessment was shown to be a reliable method to evaluate those pa tients who poorly complied with the GFD [6], The dose of gluten that is daily assumed is probably crucial in determining both the jejunal lesions and the serum AGA response [4], Congdon et al [6] suggested that the degree of mucosal damage was proportional to the amount of gluten ingested: a high glu ten intake with the diet, during gluten chal lenge, was shown to stimulate a vigorous and precocious production of specific IgA [3. 8, 11.…”

“…A possible role of AGA measurement in the assessment of the pa tient's adherence to a gluten-free diet (GFD) after the definitive diagnosis of CD has been proposed [3,4]. A high percentage of pa tients fail to comply with the protracted GFD [5][6][7], but only a few data on the corre lation between adherence to GFD and AGA titers are available today [8], We report data 1 We thank Mrs. Cristina Fiorentini for editing the manuscript.…”