Wheat starch-containing gluten-free flour products in the treatment of coeliac disease and dermatitis herpetiformis - A long-term follow-up study

Background: We investigated whether wheat starch-based gluten-free products are safe in the treatment of gluten intolerance. Methods: The study involv ed 41 children and adults with coeliac disease and 11 adults with dermatiti s herpetiformis adhering to a gluten-free diet for 8 years on average. Thir ty-five newly diagnosed coeliac patients at diagnosis and 6 to 24 months af ter the start of a gluten-free diet and 27 non-coeliac patients with dyspep sia were investigated for comparison. Daily dietary gluten and wheat starch intake were calculated. Small-bowel mucosal villous architecture, CD3(+), alpha beta(+), and gamma delta(+) intraepithelial lymphocytes, mucosal HLA- DR expression, and serum endomysial, reticulin, and gliadin antibodies were investigated. Results: Forty of 52 long-term-treated patients adhered to a strict wheat starch-based diet and 6 to a strict naturally gluten-free die t; 6 patients had dietary lapses. In the 46 patients on a strict diet the v illous architecture, enterocyte height, and density of alpha beta(+) intrae pithelial lymphocytes were similar to those in non-coeliac subjects and bet ter than in short-term-treated coeliac patients. The density of gamma delta (+) cells was higher, but they seemed to decrease over time with the gluten -free diet. Wheat starch-based gluten-free flour products did not cause abe rrant upregulation of mucosal HLA-DR. The mucosal integrity was not depende nt on the daily intake of wheat starch in all patients on a strict diet, wh ereas two of the six patients with dietary lapses had villous atrophy and p ositive serology. Conclusion: Wheat starch-based gluten-free flour products were not harmful in the treatment of coeliac disease and dermatitis herpet iformis.