Two different doses of gluten show a dose-dependent response of enteropathy but not of serological markers during gluten challenge in children with coeliac disease

In order to study dose-dependency in histopathological reactions and in cha nges of serological markers of mucosal relapse, gluten challenge was perfor med with two defined amounts of gluten in 54 children with earlier enteropa thy. Gluten was provided in the form of powder and the patients were random ly allotted to either 0.2 (group A, n = 27) or 0.5 (group B, n = 27) grams per kg body weight per day. At the start and after 4 wk of challenge a smal l intestinal biopsy was performed, Biopsy specimens were evaluated, in acco rdance with defined criteria, graded and summarized in an enteropathy score . Blood was sampled at the start and after 2 and 4 wk of challenge. Serum l evels of anti-gliadin antibodies (AGA) and anti-endomysium antibodies (EmA) were measured. Within 4 wk of challenge, 24 out of 27 patients in group A and all patients in group B had relapsed. After increasing the gluten dose to 0.5 g/kg/d juring the subsequent 4 Wk. the three non-relapsing patients also relapsed. Conclusion: The severity of mucosal inflammation was significantly higher f or group B (p = 0.04) indicating a dose-related severity of the enteropathy . No significant difference was found for maximum AGA level, or in the prop ortion of patients that converted to pathological values for AGA or EmA.