Abstract: Who warrants a gluten-free diet?

This is the full text of the poster presentation at NASPGHAN, Orlando, Florida, Oct 2006. It shows that a lot more children warrant a gluten-free diet than just those with a diagnosis of coeliac disease. It shows that the INOVA diagnostic test of IgG-gliadin is a useful diagnostic test for this condition: gluten-sensitivity.

Abstract: Who warrants a gluten-free diet?

Aim: To document the response to a gluten-free diet in children with high gliadin antibodies, but who did not have coeliac disease.

Methods: An audit of children, referred to a gastroenterology and allergy clinic, investigated by endoscopy for celiac disease during 2001-2005.

Inclusion criteria: eating gluten prior to endoscopy and blood tests; had elevated IgG-gliadin antibody (Inova Diagnostics) >14 units; had measurements of tissue transglutaminase (tTG) or endomesial antibody (EMA).

All of these children 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). They were catergorized into three groups:

* 31 (16%) had a histology diagnosis of definite celiac disease;
* 31 (16%) were deemed possible celiacs because of elevated tTG or EMA antibodies (but they had normal small bowel histology);
* 128 (67%), the majority, who did not have any evidence of celiac disease (normal histology and no elevation of tTG or EMA) they were labelled  ‘not-celiacs’.
Clinical and demographic features were similar across the three groups.

Of the 128 ‘not-celiacs’, 81 (64%) reported substantial clinical improvements on a gluten-free diet. Of the remaining 47, there were 31 who did not try a gluten-free diet, and 8 reported no benefit.
When the benefit was measured for only those who tried a gluten-free diet, then 81/97 (84%) of the “not-celiacs” got better on a gluten-free diet!

Conclusions: Many children have symptoms consistent with celiac disease, but have normal small bowel histology and normal tTG or EMA results. However, they frequently have high IgG-gliadin antibody levels.

Emphatically, these children also respond to a gluten-free diet they are gluten-sensitive. IgG-gliadin is a crucial test to detect these children.

Many more children, other than celiacs, warrant a gluten-free diet.

Intention to treat: who improved on a gluten-free diet

Patient groups

Numbers who improved gluten-free

Definite celiacs

29/31 (94%)

Possible celiacs

21/31 (68%)

Not-celiacs (gluten-sensitive)

81/128 (64%)