The Doctor Gluten Project

Aim: To document the response to a gluten-free diet in children with high gliadin antibodies, but who did not have coeliac disease.

Methods: An audit of children, referred to a gastroenterology and allergy clinic, investigated by endoscopy for celiac disease during 2001-2005.

Inclusion criteria: eating gluten prior to endoscopy and blood tests; had elevated IgG-gliadin antibody (Inova Diagnostics) >14 units; had measurements of tissue transglutaminase (tTG) or endomesial antibody (EMA).

All of these children were offered a gluten-free diet, whatever the small bowel histology appearance.

Results: There were 190 children (96 males and 94 females, mean age 5.3 years, sd 3.8). They were catergorized into three groups:

* 31 (16%) had a histology diagnosis of definite celiac disease;
* 31 (16%) were deemed possible celiacs because of elevated tTG or EMA antibodies (but they had normal small bowel histology);
* 128 (67%), the majority, who did not have any evidence of celiac disease (normal histology and no elevation of tTG or EMA) – they were labelled “not-celiacs”.
Clinical and demographic features were similar across the three groups.

Of the 128 “not-celiacs”, 81 (64%) reported substantial clinical improvements on a gluten-free diet. Of the remaining 47, there were 31 who did not try a gluten-free diet, and 8 reported no benefit.
When the benefit was measured for only those who tried a gluten-free diet, then 81/97 (84%) of the “not-celiacs” got better on a gluten-free diet!

Conclusions: Many children have symptoms consistent with celiac disease, but have normal small bowel histology and normal tTG or EMA results. However, they frequently have high IgG-gliadin antibody levels.

Emphatically, these children also respond to a gluten-free diet – they are gluten-sensitive. IgG-gliadin is a crucial test to detect these children.

Many more children, other than celiacs, warrant a gluten-free diet.

Intention to treat: who improved on a gluten-free diet?