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Gluten challenge in borderline gluten-sensitive enteropathy.
Am J Gastroenterol. 2001 May; 96(5):1464-9.AJ

Abstract

OBJECTIVES

In patients with signs and symptoms of malabsorption, suggestive of gluten-sensitive enteropathy, small intestinal biopsies sometimes only reveal infiltration of lymphocytes into the mucosal epithelium. This infiltrative lesion (Marsh I) is not a definite proof for gluten-sensitive enteropathy. However, in the present study, we aimed to show that a subgroup of these patients could ultimately be identified as being gluten sensitive.

METHODS

A total of 38 patients with a Marsh I lesion were subjected to a gluten challenge comprising 30 g of gluten added daily to a normal gluten-containing diet for 8 wk. Before and after the challenge, small intestinal biopsies were taken, and symptoms and signs of malabsorption were scored.

RESULTS

In 12 patients we demonstrated a significant change in mucosal histopathology, i.e., subtotal villous atrophy (Marsh IIIB, n = 1), partial villous atrophy (Marsh 3A, n = 6) or infiltrative-crypthyperplastic lesions (Marsh II, n = 5). In the other 26 patients, the small intestinal mucosa remained unchanged. After initiation of a gluten-free diet, follow-up small intestinal biopsies in 12 patients who initially had progressive mucosal pathology after gluten challenge showed normalization of mucosal pathology in seven cases, regression to a Marsh I lesion in four, and to a Marsh II lesion in one. Symptom relief was seen in all 12 patients. Ten of 26 patients without histological response to the gluten challenge were motivated to adhere to a gluten-free diet. Follow-up biopsies revealed unchanged Marsh I lesions in eight patients and normalization (Marsh 0) in two patients. Three patients had follow-up biopsies while on a normal diet. All had unchanged Marsh I lesions.

CONCLUSIONS

In the present study we demonstrated that a gluten challenge might be useful in identifying patients as being sensitive to gluten if initial small intestinal biopsies reveal only minor abnormalities.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, Rijnstate Hospital Arnhem, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11374684

Citation

Wahab, P J., et al. "Gluten Challenge in Borderline Gluten-sensitive Enteropathy." The American Journal of Gastroenterology, vol. 96, no. 5, 2001, pp. 1464-9.
Wahab PJ, Crusius JB, Meijer JW, et al. Gluten challenge in borderline gluten-sensitive enteropathy. Am J Gastroenterol. 2001;96(5):1464-9.
Wahab, P. J., Crusius, J. B., Meijer, J. W., & Mulder, C. J. (2001). Gluten challenge in borderline gluten-sensitive enteropathy. The American Journal of Gastroenterology, 96(5), 1464-9.
Wahab PJ, et al. Gluten Challenge in Borderline Gluten-sensitive Enteropathy. Am J Gastroenterol. 2001;96(5):1464-9. PubMed PMID: 11374684.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gluten challenge in borderline gluten-sensitive enteropathy. AU - Wahab,P J, AU - Crusius,J B, AU - Meijer,J W, AU - Mulder,C J, PY - 2001/5/26/pubmed PY - 2001/6/29/medline PY - 2001/5/26/entrez SP - 1464 EP - 9 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 96 IS - 5 N2 - OBJECTIVES: In patients with signs and symptoms of malabsorption, suggestive of gluten-sensitive enteropathy, small intestinal biopsies sometimes only reveal infiltration of lymphocytes into the mucosal epithelium. This infiltrative lesion (Marsh I) is not a definite proof for gluten-sensitive enteropathy. However, in the present study, we aimed to show that a subgroup of these patients could ultimately be identified as being gluten sensitive. METHODS: A total of 38 patients with a Marsh I lesion were subjected to a gluten challenge comprising 30 g of gluten added daily to a normal gluten-containing diet for 8 wk. Before and after the challenge, small intestinal biopsies were taken, and symptoms and signs of malabsorption were scored. RESULTS: In 12 patients we demonstrated a significant change in mucosal histopathology, i.e., subtotal villous atrophy (Marsh IIIB, n = 1), partial villous atrophy (Marsh 3A, n = 6) or infiltrative-crypthyperplastic lesions (Marsh II, n = 5). In the other 26 patients, the small intestinal mucosa remained unchanged. After initiation of a gluten-free diet, follow-up small intestinal biopsies in 12 patients who initially had progressive mucosal pathology after gluten challenge showed normalization of mucosal pathology in seven cases, regression to a Marsh I lesion in four, and to a Marsh II lesion in one. Symptom relief was seen in all 12 patients. Ten of 26 patients without histological response to the gluten challenge were motivated to adhere to a gluten-free diet. Follow-up biopsies revealed unchanged Marsh I lesions in eight patients and normalization (Marsh 0) in two patients. Three patients had follow-up biopsies while on a normal diet. All had unchanged Marsh I lesions. CONCLUSIONS: In the present study we demonstrated that a gluten challenge might be useful in identifying patients as being sensitive to gluten if initial small intestinal biopsies reveal only minor abnormalities. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/11374684/Gluten_challenge_in_borderline_gluten_sensitive_enteropathy_ L2 - https://Insights.ovid.com/pubmed?pmid=11374684 DB - PRIME DP - Unbound Medicine ER -