A gluten-free diet (GFD) is currently the only available treatment for patients with celiac disease (CD). Several clinical trials have demonstrated that most celiac patients can tolerate a medium-high quantity of oats without any negative clinical effects; however, the inclusion of oats in GFD is still a matter of debate. In this study, Italian children with CD were enrolled in a 15-month, randomized, double-blind, placebo-controlled multicenter trial. Participants were randomized in two groups following either A-B treatment (6 months of diet “A”, 3 months of standard GFD, 6 months of diet “B”), or B-A treatment (6 months of diet “B”, 3 months of standard GFD, 6 months of diet “A”). A and B diets included gluten-free (GF) products (flour, pasta, biscuits, cakes and crisp toasts) with either purified oats or placebo. Clinical data (Gastrointestinal Symptoms Rate Scale [GSRS] score) and intestinal permeability tests (IPT), were measured through the study period. Although the study is still blinded, no significant differences were found in GSRS score or the urinary lactulose/mannitol (L/M) ratio between the two groups after 6 months of treatment. These preliminary results suggest that the addition of non-contaminated oats from selected varieties in the treatment of children with CD does not determine changes in intestinal permeability and gastrointestinal symptoms.
References
[1]
Janatuinen, E.K.; Pikkarainen, P.H.; Kamppainen, T.A.; Kosma, V.M.; Jarvinen, R.M.; Uusitupa, M.I.; Julkunen, R.J. A comparison of diets with and without oats in adults with celiac disease. N. Engl. J. Med. 1995, 333, 1033–1037, doi:10.1056/NEJM199510193331602.
[2]
Srinivasan, U.; Leonard, N.; Jones, E.; Kasarda, D.D.; Weir, D.G.; O’Farrelly, C.; Feighery, C. Absence of oats toxicity in adult coeliac disease. BMJ 1996, 313, 1300–1301, doi:10.1136/bmj.313.7068.1300.
[3]
Hardman, C.M.; Gariogh, J.J.; Leonard, J.N.; Thomas, H.J.; Walker, M.M.; Lortan, J.E.; Lister, A.; Fry, L. Absence of toxicity of oats in patients with dermatitis herpetiformis. N. Engl. J. Med. 1997, 337, 1884–1887, doi:10.1056/NEJM199712253372604.
[4]
Reunala, T.; Collin, P.; Holm, K.; Pikkarainen, P.; Miettinen, A.; Vuolteenaho, N.; M？ki, M. Tolerance to oats in dermatitis herpetiformis. Gut 1998, 43, 490–493, doi:10.1136/gut.43.4.490.
[5]
Hoffenberg, E.J.; Haas, J.; Drescher, A.; Bamhurst, R.; Osberg, I.; Bao, F. A trial of oats in children with newly diagnosed celiac disease. J. Pediatr. 2000, 137, 361–366, doi:10.1067/mpd.2000.109003.
[6]
Janatuinen, E.K.; Kemppainen, T.H.; Julkunen, R.J.; Kosma, V.M.; Maki, M.; Heikkinen, M.; Uusitupa, M.I. No harm from five year ingestion of oats in coeliac disease. Gut 2002, 50, 332–335, doi:10.1136/gut.50.3.332.
[7]
Storsrud, S.; Olsson, M.; Arvidsson Lenner, M.; Nilsson, L.A.; Nilsson, O.; Kilander, A. Adult coeliac patients do tolerate large amounts of oats. Eur. J. Clin. Nutr. 2003, 57, 163–169, doi:10.1038/sj.ejcn.1601525.
[8]
H？gberg, L.; Laurin, P.; Falth-Magnusson, K.; Grant, C.; Grodzinsky, E.; Jansson, G.; Ascher, H.; Browaldh, L.; Hammersj？, J.A.; Lindberg, E.; et al. Oats to children with newly diagnosed coeliac disease: A randomised double blind study. Gut 2004, 53, 649–654, doi:10.1136/gut.2003.026948.
[9]
Holm, K.; Maki, M.; Vuolteenaho, N.; Mustalahti, K.; Ashorn, M.; Ruuska, T.; Kaukinen, K. Oats in the treatment of childhood coeliac disease: A 2-year controlled trial and a long-term clinical follow-up study. Aliment. Pharmacol. Ther. 2006, 23, 1463–1472, doi:10.1111/j.1365-2036.2006.02908.x.
[10]
Sey, M.S.; Parfitt, J.; Gregor, J. Prospective study of clinical and histological safety of pure and uncontaminated Canadian oats in the management of celiac disease. J. Parenter. Enteral. Nutr. 2011, 35, 459–464, doi:10.1177/0148607110387800.
[11]
Cooper, S.E.; Kennedy, N.P.; Mohamed, B.M.; Abuzakouk, M.; Dunne, J.; Byrne, G.; McDonald, G.; Davies, A.; Edwards, C.; Kelly, J.; et al. Immunological indicators of coeliac disease activity are not altered by long-term oats challenge. Clin. Exp. Immunol. 2013, 171, 313–318, doi:10.1111/cei.12014.
[12]
Silano, M.; Di Benedetto, R.; Maialetti, F.; De Vincenzi, A.; Calcaterra, R.; Cornell, H.J.; De Vincenzi, M. Avenins from different cultivars of oats elicit response by coeliac peripheral lymphocytes. Scand. J. Gastroenterol. 2007, 42, 1302–1305, doi:10.1080/00365520701420750.
[13]
Ballabio, C.; Uberti, F.; Manferdelli, S.; Vacca, E.; Boggini, G.; Redaelli, R.; Catassi, C.; Lionetti, E.; Pen？s, E.; Restani, P. Molecular characterisation of 36 oat varieties and in vitro assessment of their suitability for coeliacs’ diet. J. Cereal Sci. 2011, 54, 110–115, doi:10.1016/j.jcs.2011.04.004.
[14]
Comino, I.; Real, A.; de Lorenzo, L.; Cornell, H.; López-Casado, M.á.; Barro, F.; Lorite, P.; Torres, M.I.; Cebolla, A.; Sousa, C. Diversity in oat potential immunogenicity: Basis for the selection of oat varieties with no toxicity in coeliac disease. Gut 2011, 60, 915–922, doi:10.1136/gut.2010.225268.
[15]
Real, A.; Comino, I.; de Lorenzo, L.; Merchán, F.; Gil-Humanes, J.; Giménez, M.J.; López-Casado, M.á.; Torres, M.I.; Cebolla, á.; Sousa, C.; et al. Molecular and immunological characterization of gluten proteins isolated from oat cultivars that differ in toxicity for celiac disease. PLoS One 2012, 7, e48365, doi:10.1371/journal.pone.0048365.
[16]
Mujico, J.R.; Mitea, C.; Gilissen, L.J.W.J.; de Ru, A.; van Veelen, P.; Smulders, M.J.M.; Koning, F. Natural variation in avenin epitopes among oat varieties: Implications for celiac disease. J. Cereal Sci. 2011, 54, 8–12, doi:10.1016/j.jcs.2010.09.007.
[17]
Rashid, M.; Butzner, D.; Burrows, V.; Zarkadas, M.; Case, S.; Molloy, M.; Warren, R.; Pulido, O.; Switzer, C. Consumption of pure oats by individuals with celiac disease: A position statement by the Canadian Celiac Association. Can. J. Gastroenterol. 2007, 21, 649–651.
[18]
American Dietetic Association. Evidence-based nutrition practice guidelines on celiac disease. Available online: http://www.guideline.gov/content (accessed on 17 November 2013).
[19]
Generoso, M.; De Rosa, M.; De Rosa, R.; De Magistris, L.; Secondulfo, M.; Fiandra, R.; Carratù, R.; Cartenì, M.J. Cellobiose and lactulose coupled with mannitol and determined using ion-exchange chromatography with pulsed amperometric detection, are reliable probes for investigation of intestinal permeability. J. Chromatogr. B Analyt. Technol. Biomed. Life Sci. 2003, 783, 349–357, doi:10.1016/S1570-0232(02)00766-3.
[20]
Dimenas, E.; Glise, H.; Hallerback, B.; Hernqvist, H.; Svedlund, J.; Wiklund, I. Well-being and gastrointestinal symptoms among patients referred to endoscopy owing to suspected duodenal ulcer. Scand. J. Gastroenterol. 1995, 30, 1046–1052, doi:10.3109/00365529509101605.
[21]
Dimenas, E.; Carlsson, G.; Glise, H.; Israelsson, B.; Wiklund, I. Relevance of norm values as part of the documentation of quality of life instruments for use in upper gastrointestinal disease. Scand. J. Gastroenterol. Suppl. 1996, 221, 8–13.
[22]
Lohiniemi, S.; M？ki, M.; Kaukinen, K.; Laippala, P.; Collin, P. Gastrointestinal symptoms rating scale in coeliac disease patients on wheat starch-based gluten-free diets. Scand. J. Gastroenterol. 2000, 35, 947–949, doi:10.1080/003655200750023002.
[23]
Hallert, C.; Gr？nn？, C.; Grant, C.; Hultén, S.; Midhagen, G.; Str？m, M.; Svensson, H.; Valdimarsson, T.; Wickstr？m, T. Quality of life of adult coeliac patients treated for 10 years. Scand. J. Gastroenterol. 1998, 33, 933–938, doi:10.1080/003655298750026949.
[24]
Thomson, M.; Fritscher-Ravens, A.; Hall, S.; Afzal, N.; Ashwood, P.; Swain, C.P. Endoluminal gastroplication in children with significant gastro-oesophageal reflux disease. Gut 2004, 53, 1745–1750, doi:10.1136/gut.2004.041921.
[25]
Arentz-Hansen, H.; Fleckenstein, B.; Molberg, ？.; Scott, H.; Koning, F.; Jung, G.; Roepstorff, P.; Lundin, K.E.; Sollid, L.M. The molecular basis for oat intolerance in patients with celiac disease. PLoS Med. 2004, 1, e1, doi:10.1371/journal.pmed.0010001.
[26]
Vogelsang, H.; Schwarzenhofer, M.; Oberhuber, G. Changes in gastrointestinal permeability in celiac disease. Dig. Dis. 1998, 16, 333–336, doi:10.1159/000016886.
[27]
Duerksen, D.R.; Wilhelm-Boyles, C.; Parry, D.M. Intestinal permeability in long-term follow-up of patients with celiac disease on a gluten-free diet. Dig. Dis. Sci. 2005, 50, 85–90.
[28]
Vilela, E.G.; Ferrari, M.L.; de Gama Torres, H.O.; Martins, F.P.; Goulart, E.M.; Lima, A.S.; da Cunha, A.S. Intestinal permeability and antigliadin antibody test for monitoring adult patients with celiac disease. Dig. Dis. Sci. 2007, 52, 1304–1309, doi:10.1007/s10620-006-9511-8.
[29]
Catassi, C.; Fabiani, E.; R？tsch, I.M.; Bonucci, A.; Dotti, M.; Coppa, G.V.; Giorgi, P.L. Is the sugar intestinal permeability test a reliable investigation for coeliac disease screening? Gut 1997, 40, 215–217.
[30]
Kelly, C.P.; Green, P.H.; Murray, J.A.; Dimarino, A.; Colatrella, A.; Leffler, D.A.; Alexander, T.; Arsenescu, R.; Leon, F.; Jiang, J.G.; et al. Larazotide Acetate in patients with celiac disease undergoing a gluten-challenge: A randomized placebo-controlled study. Aliment. Pharmacol. Ther. 2013, 37, 252–262, doi:10.1111/apt.12147.
[31]
Leffler, D.A.; Kelly, C.P.; Abdallah, H.Z.; Colatrella, A.M.; Harris, L.A.; Leon, F.; Arterburn, L.A.; Paterson, B.M.; Lan, Z.H.; Murray, J.A. A randomized, double-blind study of larazotide acetate to prevent the activation of celiac disease during gluten challenge. Am. J. Gastroenterol. 2012, 107, 1554–1562, doi:10.1038/ajg.2012.211.
