Abstract: Who needs a gluten-free diet?

This is an important question to ask.  Traditionally, only celiac patients had been offered or prescribed a gluten-free diet.  I have found evidence to challenge that concept. I ask Who needs a gluten-free diet?

ABSTRACT: Who needs a gluten-free diet?

Ford, Rodney. P. K.
Paediatric gastroenterology and allergy clinic, Christchurch, New Zealand.

Presented at the RACP scientific meeting, Cairns, Australia, May 2006.

Aims: To examine the response to a gluten-free diet in children with high gliadin antibodies, but who did not have evidence of coeliac disease. Conventionally, a gluten-free diet is prescribed only for those with a histologic diagnosis of coeliac disease. This guideline was challenged.
Methods: A retrospective audit of children, referred to a gastroenterology and allergy clinic, investigated by endoscopy for coeliac disease, and with an elevated IgG-gliadin antibody test (during 2001-2005). Inclusion criteria were: eating gluten prior to endoscopy and blood tests; had blood tests for IgG-gliadin antibody (Inova Diagnostics) and tissue transglutaminase (tTG) or endomesial antibody (EMA); and clinical follow-up for at least three months. All these children with elevated IgG-gliadin antibodies were offered a gluten-free diet, whatever the small bowel histology appearance.
Results: There were 190 children (96 males and 94 females, mean age 5.3 years, sd 3.8): 31 (16%) had a histology diagnosis of coeliac disease; 31 (16%) were deemed possible coeliacs because of elevated tTG or EMA antibodies (they had normal small bowel histology); but the majority, 128 (67%), did not have any supportive evidence of coeliac disease labelled non-coeliacs. Clinical and demographic features were similar across these three groups.
Of the 128 non-coeliacs, 81 (76%) reported substantial clinical improvements on a gluten-free diet within three months. Of the remaining 47: 31 did not try a gluten-free diet, and 8 reported no benefit.
Conclusions: Many children have symptoms consistent with coeliac disease, but have normal small bowel histology and normal tTG or EMA results. But they frequently have high IgG-gliadin antibody levels. Notably, these children also clinically respond to a gluten-free diet – they are gluten-sensitive. IgG-gliadin is a valuable test to detect these children. Many more children, other than coeliacs, warrant a gluten-free diet.