Small- bowel mucosal changes and antibody responses after low- and moderate-dose gluten challenge in celiac disease

We challenged adult celiac patients with gluten with a view to assessing the amount needed to cause some small-bowel mucosal deterioration.Twenty-five celiac disease adults were challenged with low (1-3 g) or moderate (3-5g) doses of gluten daily for 12 weeks. Symptoms, small-bowel morphology, densities of CD3+ intraepithelial lymphocytes (IELs) and celiac serology were determined.Both moderate and low amounts of gluten induced small-bowel morphological damage in 67% of celiac patients. Moderate gluten doses also triggered mucosal inflammation and more gastrointestinal symptoms leading to premature withdrawals in seven cases. In 22% of those who developed significant small- intestinal damage, symptoms remained absent. Celiac antibodies seroconverted in 43% of the patients.Low amounts of gluten can also cause significant mucosal deterioration in the majority of the patients. As there are always some celiac disease patients who will not respond within these conditions, sample sizes must be sufficiently large to attain to statistical power in analysis.Celiac disease is an autoimmune-like systemic disorder in genetically susceptible individuals, perpetuated by daily ingested gluten cereals wheat, rye and barley and with manifestations in the small- intestinal mucosa and in organs outside the gut. The gold standard for celiac disease diagnosis is the finding of gluten-induced small-intestinal mucosal injury [1,2]. The mucosa will heal upon introduction of a gluten-free diet and the mucosal damage will reappear if gluten is reintroduced [2]. Extensive time-course studies have provided evidence that during gluten challenge an inflammatory process with a dose-dependent accumulation of intraepithelial lymphocytes (IELs) is followed by mucosal villous atrophy with crypt hyperplasia [3]. In untreated celiac disease the degree of malabsorption is determined by the length of the functionally impaired bowel and the presence of symptoms is noway related to the histological feature