Wheat-starch-based gluten-free products in the treatment of newly detected coeliac disease: prospective and randomized study

Authors

  • M. Peräaho,

    1. Departments of *Medicine and §Paediatrics, Tampere University Hospital, Tampere (also *§Medical School, University of Tampere), †Bone Research Group, UKK Institute, Tampere, and ‡Finnish Coeliac Society, Tampere, Finland
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  • K. Kaukinen,

    1. Departments of *Medicine and §Paediatrics, Tampere University Hospital, Tampere (also *§Medical School, University of Tampere), †Bone Research Group, UKK Institute, Tampere, and ‡Finnish Coeliac Society, Tampere, Finland
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  • K. Paasikivi,

    1. Departments of *Medicine and §Paediatrics, Tampere University Hospital, Tampere (also *§Medical School, University of Tampere), †Bone Research Group, UKK Institute, Tampere, and ‡Finnish Coeliac Society, Tampere, Finland
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  • H. Sievänen,

    1. Departments of *Medicine and §Paediatrics, Tampere University Hospital, Tampere (also *§Medical School, University of Tampere), †Bone Research Group, UKK Institute, Tampere, and ‡Finnish Coeliac Society, Tampere, Finland
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  • S. Lohiniemi,

    1. Departments of *Medicine and §Paediatrics, Tampere University Hospital, Tampere (also *§Medical School, University of Tampere), †Bone Research Group, UKK Institute, Tampere, and ‡Finnish Coeliac Society, Tampere, Finland
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  • M. Mäki,

    1. Departments of *Medicine and §Paediatrics, Tampere University Hospital, Tampere (also *§Medical School, University of Tampere), †Bone Research Group, UKK Institute, Tampere, and ‡Finnish Coeliac Society, Tampere, Finland
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  • P. Collin

    1. Departments of *Medicine and §Paediatrics, Tampere University Hospital, Tampere (also *§Medical School, University of Tampere), †Bone Research Group, UKK Institute, Tampere, and ‡Finnish Coeliac Society, Tampere, Finland
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Dr P. Collin, Medical School, FIN-33014, University of Tampere, Finland.
E-mail: pekka.collin@uta.fi

Summary

Background : The safety of wheat-starch-based gluten-free products in the treatment of coeliac disease is debatable. Prospective studies are lacking.

Aim : To compare the clinical, histological and serological response to a wheat-starch-based or natural gluten-free diet in patients with newly detected coeliac disease.

Methods : Fifty-seven consecutive adults with untreated coeliac disease were randomized to a wheat-starch-based or natural gluten-free diet. Clinical response, small bowel mucosal morphology, CD3+, αβ+ and γδ+ intra-epithelial lymphocytes, mucosal human leucocyte antigen-DR expression and serum endomysial, transglutaminase and gliadin antibodies were investigated before and 12 months after the introduction of the gluten-free diet. Quality of life measurements were performed by standardized questionnaires and the bone mineral density was analysed.

Results : In both groups, abdominal symptoms were alleviated equally by a strict diet. There were no differences between the groups in mucosal morphology, the density of intra-epithelial lymphocytes, serum antibodies, bone mineral density or quality of life tests at the end of the study. Four patients on a natural gluten-free diet and two on a wheat-starch-based gluten-free diet had dietary lapses; as a result, inadequate mucosal, serological and clinical recovery was observed.

Conclusions : The dietary response to a wheat-starch-based gluten-free diet was as good as that to a natural gluten-free diet in patients with newly detected coeliac disease.

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