WHEAT-STARCH INTOLERANCE IN PATIENTS WITH CELIAC-DISEASE

Objective Evaluate in patients with celiac disease the tolerance of pr olonged consumption of small amounts of gliadin contained in products containing wheat starch. Design Open 1-year trial of the addition of w heat starch to a gluten-free diet in a cohort of adult patients with b iopsy-proven celiac disease who had never consumed wheat starch. The c ontrol group consisted of patients with celiac disease who tolerated w heat starch. Subjects Seventeen patients with celiac disease and 14 co ntrol patients, all diagnosed according to criteria of the European So ciety of Pediatric Gastroenterology and Nutrition, were recruited from the Canadian Celiac Association and the Quebec Celiac Foundation. Set ting The study was conducted in the outpatient clinic of the Gastroent erology and Nutrition Service of Ste Justine Hospital, Montreal, Quebe c, Canada. Interventions Patients were asked to consume four to six po rtions daily of a wheat starch-containing product, mainly bread, for u p to 1 year. Main outcome measures The gliadin content of the wheat st arch product used in this trial was quantified by enzyme-linked immuno sorbent assay. Patient outcome measures included symptoms, nutritional parameters (anthropometric data, complete blood count, serum folate a nd iron levels), and immunologic parameters (antigliadin antibody and antiendomysium antibody titers). Results A quantifiable amount of immu noreactive gliadin (0.75 mg/100 g) was found in the wheat starch. The majority of the patients with celiac disease (11 of 17) who had never consumed wheat starch previously developed symptoms, which resolved wi thin weeks of discontinuing the product. Relapse of skin lesions was s een in two of three patients with coexisting dermatitis herpetiformis. No weight loss or biochemical changes were observed. Despite the pres ence of symptoms, antigliadin antibody and antiendomysium antibody det erminations were not useful to detect the clinical intolerance. Applic ations The innocuousness of the long-term ingestion of ''gluten-free'' products containing wheat starch is still unproven, and prolonged use of such products by patients with celiac disease cannot be recommende d.