ABSTRACT: Gluten reactions: ten times the celiac problem
Ford, Rodney. P. K.
Children s gastroenterology and allergy clinic, Christchurch, New Zealand.
Abstract of the paper ‘Gluten reactions: ten times the celiac problem’ – a Poster presentation at NASPGHAN, Orlando, Florida, Oct 2006
Aim: To test if children, with raised gliadin antibodies, respond to a gluten-free diet. Currently, a gluten-free diet is limited to celiac disease. This belief is contested.
Methods: An audit of 921 children referred to a gastroenterology and allergy clinic, over five years (2001-2005). These children were investigated with blood tests for celiac disease with IgG-gliadin antibody (Inova Diagnostics) and tissue transglutaminase (tTG) or endomesial antibody (EMA). Of these, 190 had a small bowel biopsy.
Results: There were 724 with high IgG-gliadin levels (>14 units): mean age 5.3 years, s.d. 3.8. All were offered a gluten-free diet. They were divided into 3 categories:
- 31 (4.3%) were Definite celiacs with histology diagnosis.
- 48 (6.6%) were deemed Possible celiacs because of elevated tTG or EMA antibodies but with normal small bowel histology.
- 644 (89.1%), had no evidence of gut damage labelled Not-celiacs .
Clinical features were similar across these three groups, although the Definite celiacs had more gut symptoms and fewer food allergies.
Gluten-free outcomes: Of the 644 Not-celiacs , 434 trialled a gluten-free diet: 343 (79%) reported substantial improvement. However, when calculated on intention to treat, improvement was seen in 94% of Definite celiacs ; 75% of Possible celiacs ; and 53% of Not-celiacs . Gluten-sensitivity was seen ten times more frequently than celiac disease: 379 vs 31.
Conclusions: Many children with gastrointestinal and allergy conditions have high IgG-gliadin antibodies. When given a gluten-free diet, the majority got better they were gluten-sensitive. High IgG-gliadin levels can identify these children.
Gluten-sensitivity occurred ten times the rate of celiac disease.
Response rate to gluten free diet
Patient group Intention to treat:
improved on gluten-free diet
Definite celiacs 29/31 (94%)
Possible celiacs 36/48 (75%)
Not-celiacs (gluten-sensitive) 343/644 (53%)