Persistent mucosal abnormalities in coeliac disease are not related to theingestion of trace amounts of gluten

Background: It is expected that in patients with coeliac disease the small- bower mucosal mucosa will return to normal if they adhere to a gluten-free diet (GFD). However, in many this is not the case. This study aims to deter mine whether this persistent villous atrophy (VA) could be due to continued ingestion of the trace amounts of gluten in 'gluten-free' foods, as define d by the WHO/FAO Coder Alimentarius. Methods: Duodenal biopsy specimens fro m 89 adults with long-standing coeliac disease were examined, and the findi ngs correlated with their form of gluten-free diet. Results: In 51 subjects the duodenal specimen was normal, whereas in 38 there was villous atrophy (partial, 28; subtotal, 8 total, 2). There was no relationship between the presence or absence of VA and ingestion of either a GFD as defined by the C oder Alimentarius (Codex-GFD; 39 patients) or a GFD that contained no detec table gluten (NDG diet; 50 patients). Intraepithelial lymphocyte counts wer e higher, and lactase levels lower, in subjects with an abnormal biopsy spe cimen than in those in whom it was normal. However, within each of these bi opsy groups there was no difference in these variables between patients on a Codex-GFD and those on an NDG-GFD. IgA antigliadin antibody was detected in 4 of 29 patients on a Codex-GFD and in 3 of 13 on a NDG-GFD (NS). Conclu sion: The persistent mucosal abnormalities seen in patients with coeliac di sease on a GFD are not due to the ingestion of trace amounts of gluten. The consequences of these abnormalities have yet to be determined.