Background: Coeliac disease is an inflammatory disorder characterized by re
versible atrophy of small intestinal villi following the ingestion of glute
n. Earlier studies indicate that the inflammatory response to gluten may oc
cur also very distally in the gastrointestinal tract. The aim of this study
was to evaluate whether rectal challenge with gluten would trigger an incr
eased local production of the gas nitric oxide (NO), a novel marker of inte
stinal inflammation. Methods: Rectal challenge with partially digested glut
en was performed in 20 patients with treated coeliac disease and in 13 heal
thy controls. Luminal levels of NO were measured in the rectum at 0, 8 and
24 h using a chemiluminescence technique. Results: In patients with coeliac
disease mean rectal NO increased from 235 +/- 90 parts per billion (ppb) a
t 0 h to 4965 +/- 1653 ppb at 24 h (P < 0.005). In the control group there
was no significant increase. One control subject responded with high NO lev
els at 24 h and the same individual tested positive for anti-endomysium IgA
antibodies. Subsequent duodenal biopsing showed substantial villusatrophy.
Conclusions: Rectal challenge with gluten results in increased luminal lev
els of NO in a group of patients with treated coeliac disease. Further stud
ies are needed to evaluate the role of NO in coeliac disease and the potent
ial usefulness of rectal NO measurements in aiding diagnosis of this intest
inal disorder.