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Gluten sensitivity in the rectal mucosa of first-degree relatives of celiac disease patients.
Am J Gastroenterol 1997; 92(8):1326-30AJ

Abstract

BACKGROUND/AIMS

Rectal gluten challenge is a simple, sensitive, and specific test of mucosal gluten sensitivity. Our aims in this study were to evaluate gluten sensitivity in a group of relatives of celiac patients and to compare these findings with those obtained on small bowel histology, celiac disease-related serology, and HLA typing.

METHODS

A 4-h rectal gluten challenge was performed with 6 g of crude gluten in saline solution in 29 first-degree relatives, 20 well-diagnosed celiac patients, and 10 subjects in whom celiac disease had been excluded. The number of intraepithelial lymphocytes in pre- and postchallenge frozen rectal biopsies (pan T-cell immunocytochemistry) was quantified by computerized image analysis.

RESULTS

The intraepithelial lymphocyte response after gluten instillation was significantly higher in celiac disease patients (median, 126% increase above the baseline count; 95% confidence interval: 61-213%) compared with control subjects (median, -5%; 95% confidence interval: -29-5%). Using a cut-off of 20% change in intraepithelial lymphocyte count, 14 relatives (48%) showed a celiac-like response. Two of these subjects had partial villous atrophy and increased lymphocyte counts in the small bowel mucosa. One of them also exhibited a positive celiac disease-related serology and the typical celiac human lymphocyte antibody (HLA) DQ2. The remaining 12, and all those relatives with a negative challenge, had normal small bowel mucosa and were negative for antigliadin and endomysial antibodies. The characteristic celiac HLA (DQA1 0501 DQB1 0201 heterodimer) was identified in five relatives with positive challenge (including the patient with more severe mucosal atrophy) but was also present in eight relatives with no evidence of gluten sensitivity in the rectal mucosa.

CONCLUSIONS

Our study characterizes a subgroup of relatives of celiac patients who show mucosal evidence of sensitization after local instillation of gluten in the rectum but who have no other features of celiac disease.

Authors+Show Affiliations

Clinical Department, Gastroenterology Hospital Dr. Carlos Bonorino Udaondo, Universidad del Salvador, Buenos Aires, Argentina.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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

Language

eng

PubMed ID

9260799

Citation

Dezi, R, et al. "Gluten Sensitivity in the Rectal Mucosa of First-degree Relatives of Celiac Disease Patients." The American Journal of Gastroenterology, vol. 92, no. 8, 1997, pp. 1326-30.
Dezi R, Niveloni S, Sugai E, et al. Gluten sensitivity in the rectal mucosa of first-degree relatives of celiac disease patients. Am J Gastroenterol. 1997;92(8):1326-30.
Dezi, R., Niveloni, S., Sugai, E., Pedreira, S., Smecuol, E., Vazquez, H., ... Bai, J. C. (1997). Gluten sensitivity in the rectal mucosa of first-degree relatives of celiac disease patients. The American Journal of Gastroenterology, 92(8), pp. 1326-30.
Dezi R, et al. Gluten Sensitivity in the Rectal Mucosa of First-degree Relatives of Celiac Disease Patients. Am J Gastroenterol. 1997;92(8):1326-30. PubMed PMID: 9260799.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gluten sensitivity in the rectal mucosa of first-degree relatives of celiac disease patients. AU - Dezi,R, AU - Niveloni,S, AU - Sugai,E, AU - Pedreira,S, AU - Smecuol,E, AU - Vazquez,H, AU - Doldan,I, AU - Cabanne,A, AU - Boerr,L, AU - Valero,J, AU - Kogan,Z, AU - Mauriño,E, AU - Bai,J C, PY - 1997/8/1/pubmed PY - 1997/8/1/medline PY - 1997/8/1/entrez SP - 1326 EP - 30 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 92 IS - 8 N2 - BACKGROUND/AIMS: Rectal gluten challenge is a simple, sensitive, and specific test of mucosal gluten sensitivity. Our aims in this study were to evaluate gluten sensitivity in a group of relatives of celiac patients and to compare these findings with those obtained on small bowel histology, celiac disease-related serology, and HLA typing. METHODS: A 4-h rectal gluten challenge was performed with 6 g of crude gluten in saline solution in 29 first-degree relatives, 20 well-diagnosed celiac patients, and 10 subjects in whom celiac disease had been excluded. The number of intraepithelial lymphocytes in pre- and postchallenge frozen rectal biopsies (pan T-cell immunocytochemistry) was quantified by computerized image analysis. RESULTS: The intraepithelial lymphocyte response after gluten instillation was significantly higher in celiac disease patients (median, 126% increase above the baseline count; 95% confidence interval: 61-213%) compared with control subjects (median, -5%; 95% confidence interval: -29-5%). Using a cut-off of 20% change in intraepithelial lymphocyte count, 14 relatives (48%) showed a celiac-like response. Two of these subjects had partial villous atrophy and increased lymphocyte counts in the small bowel mucosa. One of them also exhibited a positive celiac disease-related serology and the typical celiac human lymphocyte antibody (HLA) DQ2. The remaining 12, and all those relatives with a negative challenge, had normal small bowel mucosa and were negative for antigliadin and endomysial antibodies. The characteristic celiac HLA (DQA1 0501 DQB1 0201 heterodimer) was identified in five relatives with positive challenge (including the patient with more severe mucosal atrophy) but was also present in eight relatives with no evidence of gluten sensitivity in the rectal mucosa. CONCLUSIONS: Our study characterizes a subgroup of relatives of celiac patients who show mucosal evidence of sensitization after local instillation of gluten in the rectum but who have no other features of celiac disease. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/9260799/Gluten_sensitivity_in_the_rectal_mucosa_of_first_degree_relatives_of_celiac_disease_patients_ L2 - http://www.diseaseinfosearch.org/result/1186 DB - PRIME DP - Unbound Medicine ER -