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. 1989 Nov;64(11):1604–1607. doi: 10.1136/adc.64.11.1604

Postpubertal gluten challenge in coeliac disease.

M Mäki 1, M L Lähdeaho 1, O Hällström 1, M Viander 1, J K Visakorpi 1
PMCID: PMC1792633  PMID: 2604420

Abstract

Altogether 38 postpubertal children with coeliac disease were rebiopsied. Mucosal abnormality in nine (24%) of them indicated poor adherence to the diet. Gluten challenge with a diet containing a normal amount of gluten was performed in those 29 patients with a normal mucosa. During challenge, rebiopsy was done when reticulin antibodies turned positive (mean 0.6 years, range 0.2-2.0) or at the end of the two year study. Histologically a clear relapse into coeliac disease was seen in all 23 patients who were positive for reticulin antibodies. At this time gliadin antibodies were positive in all but two. Sixteen (70%) of those who relapsed were completely asymptomatic. Three girls and one boy did not relapse within two years, indicating the possible recovery from coeliac disease to be 11%. All four had undergone gluten challenge earlier in childhood, after initial diagnosis and mucosal recovery, and this had resulted in mucosal relapse. To establish definite postpubertal recovery from coeliac disease in cases with normal mucosa at two years from challenge, further follow up studies of reticulin antibodies and later rebiopsy are needed. The reticulin antibody test seems to be suitable for prediction of mucosal relapse in coeliac disease.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aine L. Dental enamel defects and dental maturity in children and adolescents with coeliac disease. Proc Finn Dent Soc. 1986;82 (Suppl 3):1–71. [PubMed] [Google Scholar]
  2. Kagnoff M. F., Austin R. K., Hubert J. J., Bernardin J. E., Kasarda D. D. Possible role for a human adenovirus in the pathogenesis of celiac disease. J Exp Med. 1984 Nov 1;160(5):1544–1557. doi: 10.1084/jem.160.5.1544. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Kagnoff M. F., Paterson Y. J., Kumar P. J., Kasarda D. D., Carbone F. R., Unsworth D. J., Austin R. K. Evidence for the role of a human intestinal adenovirus in the pathogenesis of coeliac disease. Gut. 1987 Aug;28(8):995–1001. doi: 10.1136/gut.28.8.995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Kuitunen P., Savilahti E., Verkasalo M. Late mucosal relapse in a boy with coeliac disease and cow's milk allergy. Acta Paediatr Scand. 1986 Mar;75(2):340–342. doi: 10.1111/j.1651-2227.1986.tb10212.x. [DOI] [PubMed] [Google Scholar]
  5. Kumar P. J., O'Donoghue D. P., Stenson K., Dawson A. M. Reintroduction of gluten in adults and children with treated coeliac disease. Gut. 1979 Sep;20(9):743–749. doi: 10.1136/gut.20.9.743. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Kumar P. J., Walker-Smith J., Milla P., Harris G., Colyer J., Halliday R. The teenage coeliac: follow up study of 102 patients. Arch Dis Child. 1988 Aug;63(8):916–920. doi: 10.1136/adc.63.8.916. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Logan R. F., Tucker G., Rifkind E. A., Heading R. C., Ferguson A. Changes in clinical features of coeliac disease in adults in Edinburgh and the Lothians 1960-79. Br Med J (Clin Res Ed) 1983 Jan 8;286(6359):95–97. doi: 10.1136/bmj.286.6359.95. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. McNeish A. S., Harms H. K., Rey J., Shmerling D. H., Visakorpi J. K., Walker-Smith J. A. The diagnosis of coeliac disease. A commentary on the current practices of members of the European Society for Paediatric Gastroenterology and Nutrition (ESPGAN). Arch Dis Child. 1979 Oct;54(10):783–786. doi: 10.1136/adc.54.10.783. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Mulder C. J., Tytgat G. N. Coeliac disease and related disorders. Neth J Med. 1987 Dec;31(5-6):286–299. [PubMed] [Google Scholar]
  10. Mäki M., Hällström O., Vesikari T., Visakorpi J. K. Evaluation of a serum IgA-class reticulin antibody test for the detection of childhood celiac disease. J Pediatr. 1984 Dec;105(6):901–905. doi: 10.1016/s0022-3476(84)80074-8. [DOI] [PubMed] [Google Scholar]
  11. Mäki M., Kallonen K., Lähdeaho M. L., Visakorpi J. K. Changing pattern of childhood coeliac disease in Finland. Acta Paediatr Scand. 1988 May;77(3):408–412. doi: 10.1111/j.1651-2227.1988.tb10668.x. [DOI] [PubMed] [Google Scholar]
  12. Packer S. M., Charlton V., Keeling J. W., Risdon R. A., Ogilvie D., Rowlatt R. J., Larcher V. F., Harries J. T. Gluten challenge in treated coeliac disease. Arch Dis Child. 1978 Jun;53(6):449–455. doi: 10.1136/adc.53.6.449. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Rizzetto M., Doniach D. Types of 'reticulin' antibodies detected in human sera by immunofluorescence. J Clin Pathol. 1973 Nov;26(11):841–851. doi: 10.1136/jcp.26.11.841. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Savilahti E., Viander M., Perkkiö M., Vainio E., Kalimo K., Reunala T. IgA antigliadin antibodies: a marker of mucosal damage in childhood coeliac disease. Lancet. 1983 Feb 12;1(8320):320–322. doi: 10.1016/s0140-6736(83)91627-6. [DOI] [PubMed] [Google Scholar]
  15. Shmerling D. H., Franckx J. Childhood celiac disease: a long-term analysis of relapses in 91 patients. J Pediatr Gastroenterol Nutr. 1986 Jul-Aug;5(4):565–569. [PubMed] [Google Scholar]
  16. Ståhlberg M. R., Hietanen E., Mäki M. Mucosal biotransformation rates in the small intestine of children. Gut. 1988 Aug;29(8):1058–1063. doi: 10.1136/gut.29.8.1058. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Swinson C. M., Levi A. J. Is coeliac disease underdiagnosed? Br Med J. 1980 Nov 8;281(6250):1258–1260. doi: 10.1136/bmj.281.6250.1258. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Vainio E., Kalimo K., Reunala T., Viander M., Palosuo T. Circulating IgA- and IgG-class antigliadin antibodies in dermatitis herpetiformis detected by enzyme-linked immunosorbent assay. Arch Dermatol Res. 1983;275(1):15–18. doi: 10.1007/BF00516548. [DOI] [PubMed] [Google Scholar]

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