Shorter gluten challenge, same results

By Jason Clevenger

Summary: A study by a group of American researchers affiliated with the Celiac Center of the Beth Israel Deaconess Medical Center in Boston suggests that duration of gluten challenge can be significantly reduced from present practice. During a challenge, patients purposely consume a controlled amount of gluten for a set amount of time. It’s a useful tool for celiac disease diagnosis.

In this study, 20 biopsy-proven celiac disease patients were subjected to a gluten challenge of either 3 or 7.5 grams per day for a total of 28 days. Blood tests were performed on each patient at the 3-, 7-, 14- and 28-day marks while a duodenal biopsy was performed on days 3 and 14. Results suggest that more than 75 percent of adults would reach diagnostic criteria of a positive celiac disease diagnosis after only two weeks of gluten challenge. In addition, the researchers found no difference in results based on which of the two doses of gluten was consumed.

Conclusion: The gluten challenge is a useful screening tool to confirm a diagnosis of celiac disease in borderline cases. It also helps determine how well a drug or other treatment may work. Unfortunately, the current protocol of ingesting 10 to 12 grams (the equivalent of four slices of bread) for six to eight weeks is poorly tolerated by most patients and is a barrier to patient acceptance. This study suggests that a clinically relevant diagnosis could be obtained with a much lower gluten dose in a much shorter period of time.

 

[1] “Kinetics of the histological, serological and symptomatic responses to gluten challenge in adults with coeliac disease”, D. Leffler, D. Schuppan, K. Pallav, R. Najarian, J.D. Goldsmith, J. Hansen, T. Kabbani, M. Dennis, C.P. Kelly, Gut, May 2012, epub ahead of print.