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Gluten tolerance in adult patients with celiac disease 20 years after diagnosis?
Eur J Gastroenterol Hepatol 2008; 20(5):423-9EJ

Abstract

BACKGROUND AND OBJECTIVE

Celiac disease (CD) is believed to be a permanent intolerance to gluten. A number of patients, however, discontinue the gluten-free diet (GFD) without developing symptoms or signs. The aim of our study was to investigate whether CD patients are capable of developing tolerance to gluten.

METHODS

All 77 adult patients from our hospital known to have biopsy-proven CD for more than 10 years were invited to participate. We investigated symptoms, gluten consumption, antibodies for CD and other autoimmunity, human leukocyte antigen (HLA)-typing, bone mineral density, and performed small bowel biopsies. Tolerance was defined as no immunological or histological signs of CD while consuming gluten.

RESULTS

Sixty-six patients accepted participation, but after review of the diagnostic biopsies 53 were found to have true CD. Twenty-three percent of patients had a gluten-containing diet, 15% admitted gluten transgression and 62% followed the GFD. Patients on a GFD had significantly more osteoporosis. Normal small bowel mucosa was found in four of eight on gluten-containing diet and in four of four with gluten transgression. Two patients were considered to have developed tolerance to gluten. One of them was HLA-DQ2/DQ8 negative.

CONCLUSION

Development of tolerance to gluten seems possible in some patients with CD. Further follow-up will show whether this tolerance is permanent or only a long-term return to latency. This feature may be associated with genetic characteristics, especially with HLA genotypes that differ from DQ2 or DQ8. More insight into the mechanisms of the development of gluten tolerance may help to distinguish those CD patients that might not require life-long GFD.

Authors+Show Affiliations

Department of Dietetics and Nutrition, Leiden University Medical Center, Leiden, The Netherlands. G.D.Hopman@lumc.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18403944

Citation

Hopman, Erica G D., et al. "Gluten Tolerance in Adult Patients With Celiac Disease 20 Years After Diagnosis?" European Journal of Gastroenterology & Hepatology, vol. 20, no. 5, 2008, pp. 423-9.
Hopman EG, von Blomberg ME, Batstra MR, et al. Gluten tolerance in adult patients with celiac disease 20 years after diagnosis? Eur J Gastroenterol Hepatol. 2008;20(5):423-9.
Hopman, E. G., von Blomberg, M. E., Batstra, M. R., Morreau, H., Dekker, F. W., Koning, F., ... Mearin, M. L. (2008). Gluten tolerance in adult patients with celiac disease 20 years after diagnosis? European Journal of Gastroenterology & Hepatology, 20(5), pp. 423-9. doi:10.1097/MEG.0b013e3282f4de6e.
Hopman EG, et al. Gluten Tolerance in Adult Patients With Celiac Disease 20 Years After Diagnosis. Eur J Gastroenterol Hepatol. 2008;20(5):423-9. PubMed PMID: 18403944.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gluten tolerance in adult patients with celiac disease 20 years after diagnosis? AU - Hopman,Erica G D, AU - von Blomberg,Mary E, AU - Batstra,Manou R, AU - Morreau,Hans, AU - Dekker,Friedo W, AU - Koning,Frits, AU - Lamers,Cor B H W, AU - Mearin,Maria Luisa, PY - 2008/4/12/pubmed PY - 2008/8/22/medline PY - 2008/4/12/entrez SP - 423 EP - 9 JF - European journal of gastroenterology & hepatology JO - Eur J Gastroenterol Hepatol VL - 20 IS - 5 N2 - BACKGROUND AND OBJECTIVE: Celiac disease (CD) is believed to be a permanent intolerance to gluten. A number of patients, however, discontinue the gluten-free diet (GFD) without developing symptoms or signs. The aim of our study was to investigate whether CD patients are capable of developing tolerance to gluten. METHODS: All 77 adult patients from our hospital known to have biopsy-proven CD for more than 10 years were invited to participate. We investigated symptoms, gluten consumption, antibodies for CD and other autoimmunity, human leukocyte antigen (HLA)-typing, bone mineral density, and performed small bowel biopsies. Tolerance was defined as no immunological or histological signs of CD while consuming gluten. RESULTS: Sixty-six patients accepted participation, but after review of the diagnostic biopsies 53 were found to have true CD. Twenty-three percent of patients had a gluten-containing diet, 15% admitted gluten transgression and 62% followed the GFD. Patients on a GFD had significantly more osteoporosis. Normal small bowel mucosa was found in four of eight on gluten-containing diet and in four of four with gluten transgression. Two patients were considered to have developed tolerance to gluten. One of them was HLA-DQ2/DQ8 negative. CONCLUSION: Development of tolerance to gluten seems possible in some patients with CD. Further follow-up will show whether this tolerance is permanent or only a long-term return to latency. This feature may be associated with genetic characteristics, especially with HLA genotypes that differ from DQ2 or DQ8. More insight into the mechanisms of the development of gluten tolerance may help to distinguish those CD patients that might not require life-long GFD. SN - 0954-691X UR - https://www.unboundmedicine.com/medline/citation/18403944/Gluten_tolerance_in_adult_patients_with_celiac_disease_20_years_after_diagnosis L2 - http://Insights.ovid.com/pubmed?pmid=18403944 DB - PRIME DP - Unbound Medicine ER -