Small- bowel mucosal changes and antibody responses after low- and moderate-dose gluten challenge in celiac disease

Table 2 Effect of moderate (3-5g) and low (1-3g) amounts of gluten on small-bowel mucosal villous height crypt depth ratio (Vh/CrD), densities of CD3+ intraepithelial lymphocytes (IELs) and gastrointestinal symptoms in treated celiac disease patients.

No	Mean daily gluten intake (g)	Duration of gluten challenge (days)	Small-bowel biopsy				Symptoms‡
			Vh/CrD*		CD3+ IELs†
			I	II	I	II	I	II
Moderate amounts of gluten daily
1	5.0	29	2.8	0.8	33	88	0	++
2	4.9	84	3.5	3.4	43	84	0	0
3	4.9	38	2.9	1.3	64	128	0	++
4	4.7	45	2.7	0.2	70	113	0	+
5	4.1	61	3.0	3.5	41	56	0	++
6	4.0	91	3.0	0.6	45	97	0	+
7	3.6	91	2.8	1.4	42	125	0	0
8	3.6	84	3.0	2.6	38	47	0	+
9	3.4	88	3.8	2.3	69	83	0	+
10	3.3	86	2.7	0.6	68	96	0	+
Low amounts of gluten daily
11	2.8	89	2.5	3.1	87	52	0	+
12	2.7	84	3.0	0.6	87	117	0	0
13	2.6	81	2.9	3.1	49	50	0	0
14	2.4	85	2.7	1.9	146	271	0	+
15	2.2	103	4.2	1.3	23	48	0	+
16	2.1	93	1.3	0.1	130	99	0	+
17	2.1	85	3.3	2.4	100	79	0	+
18	2.1	84	2.9	1.7	75	78	0	0
19	2.1	83	3.2	3.4	70	123	0	+
20	1.4	77	3.4	3.0	41	87	0	++
21	1.3	78	2.5	0.8	53	71	0	0
Altogether positive outcome§, n (%)			14 (67%)		14 (67%)		15 (71%)

Clinically significant changes between baseline (I) and 12 weeks' follow-up examination (II) are marked in bold numbers. Complete challenge lasted 12 weeks (84 ± 14 days).
* Abnormal ratio compatible with active celiac disease <2.0
† Reference value for CD3+ IELs 37 cell/mm
‡ Symptoms graded as 0 = no symptoms, + = mild symptoms, ++ = moderate symptoms,
§ Positive outcome reported when clinically significant changes appeared (>0.5 decrease in Vh/CrD, >30% increase in IEL densities) or when symptoms worsened.

ISSN: 1471-230X