The Doctor Gluten Project

“My daughter Stella has been on a gluten-free diet for two months. There has been an improvement.  However, she is due to have her small bowel biopsy to test her for celiac's disease.  How long does she need go back on gluten before she has this endoscopy to obtain the correct results?"   Regards, Wendy.

My Reply:

There is no specific answer to this question.  Unfortunately, there is nothing exact about gluten!

There are a number of factors that will influence the biopsy result: her age (some children take years to develop the gut damage); the amount of gluten she eats; her susceptibility to gluten (can be assessed by her IgG-gliadin levels); her degree of gut damage (can be assessed by her tTG levels); her HLA genetic markers (HLA DQ2/DQ8); how sick she gets with the gluten challenge; and how experienced the endoscopist and histologist are to find and detect any gut damage.

It turns out that most people who get sick with gluten do not have coeliac disease - they have "non-coeliac gluten-sensitivity".  In those people, after getting sick on a gluten challenge their gut still looks normal.

If her blood tests early on showed a high tTG, then she may have significant gut damage after about three months eating gluten.  A gluten challenge is at least a slice of bread a day (and preferably more).  Cheers, Dr Rodney Ford.