DOSE-DEPENDENT EFFECTS OF PROTRACTED INGESTION OF SMALL AMOUNTS OF GLIADIN IN CELIAC-DISEASE CHILDREN - A CLINICAL AND JEJUNAL MORPHOMETRICSTUDY

This study aimed to investigate the effects of chronic ingestion of sm all amounts of gliadin on children with coeliac disease. A four week c hallenge was performed on 20 children who had been on a gluten free di et for mean (SD) 14 (3) months. They were given a daily dose of either 100 mg (group A, n=10, mean age 4 (2) years) or 500 mg of gliadin (gr oup B, mean age 5 (3) years). The effects of the gliadin were monitore d by morphometric study of the jejunal mucosa, intestinal permeability test with cellobiose/mannitol, and serum antigliadin antibody test. A fter the challenge, group A patients showed a significant increase in the mean intraepithelial lymphocyte count (before challenge 11 (3), af terwards 19 (6)) and a decrease in the villous height/crypt depth rati o (beforehand 1.5 (0.1), afterwards 1.3 (0.2)), while the intestinal p ermeability test remained normal and the IgA-antigliadin antibody incr eased in four of 10 children. After the challenge group B showed more pronounced histological changes, an increase in the mean urinary cello biose/mannitol % (beforehand 0.028 (0.020), afterwards 0.058 (0.028)), and IgA-antigliadin antibody positivity in six of eight subjects. The discriminant analysis function showed that the pretreatment group, gr oup A after challenge, and group B after challenge were correctly clas sified in 90% of cases by functions based on the individual intraepith elial lymphocyte count and the villous height/crypt depth ratio. This study shows that chronic ingestion of small amounts of gluten causes d ose-dependent damage to the small intestinal mucosa in children with c oeliac disease. The predictive value of laboratory tests, such as the antigliadin antibody test and the intestinal permeability test seems t o be lower in treated patients than in those with active coeliac disea se.