Abstract
Intestinal permeability is frequently abnormal in patients with celiac disease. The long-term effect of a gluten-free diet on intestinal permeability and the correlation of intestinal permeability with a gluten-free diet are not known. The objectives of this study were to determine the responses of intestinal permeability and antibody testing to gluten free diet and the degree of correlation of these measurements with gluten ingestion. In this prospective study, patients with celiac disease were divided into three groups based on length of time on a gluten-free diet: Group A, < 1 month; Group B, 1 month–1 year; Group C, > 1 year. Patients in Groups B and C were tested at baseline and at 4–12 weeks later for the following: lactulose/mannitol intestinal permeability, endomysial antibody, and 3-day food record. Permeability tests were also performed in Group A and control subjects. Intestinal permeability was elevated in newly diagnosed celiac disease and in individuals on a gluten-free diet for less than 1 year. Intestinal permeability was normal in 80% at visit 1 and 87% at visit 2 in individuals with celiac disease on a gluten-free diet for more than a year. Trace gluten ingestion was associated with increased intestinal permeability on visit 2 (P = 0.0480). The sensitivity of detecting gluten ingestion as measured by a 3-day food record was higher for permeability testing (29 and 36%) compared with endomysial antibody testing (18 and 18%) for visits 1 and 2, respectively. Intestinal permeability normalizes in the majority of individuals with celiac disease on a gluten-free diet. Gluten ingestion as measured by a 3-day food record correlates with intestinal permeability measurements. The role of permeability testing in the follow-up of patients with celiac disease warrants further investigation.
Similar content being viewed by others
References
Johnston SD, Smye M, Watson RG, McMillan SA, Trimble ER, Love AH: Lactulose-mannitol intestinal permeability test: a useful screening test for adult coeliac disease. Ann Clin Biochem 37(Pt 4):512–519, 2000
Smecuol E, Vazquez H, Sugai E, et al.: Sugar tests detect celiac disease among first-degree relatives. Am J Gastroenterol 94(12):3547–3552, 1999
Smecuol E, Bai JC, Vazquez H, et al.: Gastrointestinal permeability in celiac disease [see comments]. Gastroenterology 112(4):1129–1136, 1997
Kohout P: Small bowel permeability in daignosis of celiac disease and monitoring of compliance of a gluten-free diet (gut permeability in celiac disease). Acta Med 44:101–104, 2001
van Elburg RM, Uil JJ, de Monchy JG, Heymans HS: Intestinal permeability in pediatric gastroenterology. Scand J Gastroenterol Suppl 194:19–24, 1992
Bardella MT, Molteni N, Prampolini L, et al.: Need for follow up in coeliac disease. Arch Dis Child 70(3):211–213, 1994
Mayer M, Greco L, Troncone R, Auricchio S, Marsh MN: Compliance of adolescents with coeliac disease with a gluten free diet. Gut 32(8):881–885, 1991
Ciacci C, Mazzacca G: Unintentional gluten ingestion in celiac patients [letter]. Gastroenterology 115(1):243, 1998
Farrell RJ, Kelly CP: Celiac sprue. N Engl J Med 346(3):180–188, 2002
Auricchio S, Troncone R: Effects of small amounts of gluten in the diet of coeliac patients. Panminerva Med 33(2):83–85, 1991
Dickey W, McMillan SA, Callender ME: High prevalence of celiac sprue among patients with primary biliary cirrhosis. J Clin Gastroenterol 25(1):328–329, 1997
Vahedi K, Mascart F, Mary JY, et al.: Reliability of antitransglutaminase antibodies as predictors of gluten-free diet compliance in adult celiac disease. Am J Gastroenterol 98(5):1079–1087, 2003
Uil JJ, van Elburg RR, Janssens PMW, Mulder CJJ, Heymans HSA: Sensitivity of a hyperosmolar or low-osmolar test solution for sugar absorption in recognizing small intestinal mucosal damage in coeliac disease. Digest Liver Dis 32:195–200, 2000
Mariani P, Viti MG, Montuori M, et al.: The gluten-free diet: a nutritional risk factor for adolescents with celiac disease? J Pediatr Gastroenterol Nutr 27(5):519–523, 1998
Menzies IS: Intestinal permeability in coeliac disease. Gut 13(10):847, 1972
Chadwick VS, Phillips SF, Hofmann AF: Measurements of intestinal permeability using low molecular weight polyethylene glycols (PEG 400). II. Application to normal and abnormal permeability states in man and animals. Gastroenterology 73(2):247–251, 1977
Ciacci C, Cirillo M, Cavallaro R, Mazzacca G: Long-term follow-up of celiac adults on gluten-free diet: prevalence and correlates of intestinal damage. Digestion 66(3):178–185, 2002
Murray JA: The widening spectrum of celiac disease. Am J Clin Nutr 69(3):354–365, 1999
Ukabam SO, Cooper BT: Small intestinal permeability as an indicator of jejunal mucosal recovery in patients with celiac sprue on a gluten-free diet. J Clin Gastroenterol 7(3):232–236, 1985
Cummins AG, Thompson FM, Butler RN, et al.: Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clin Sci (Lond) 100(4):379–386, 2001
Uil JJ, van-Elburg RM, van-Overbeek FM, Meyer JW, Mulder CJ, Heymans HS: Follow-up of treated coeliac patients: sugar absorption test and intestinal biopsies compared. Eur J Gastroenterol Hepatol 8(3):219–223, 1996
Fasano A, Not T, Wang W, et al.: Zonulin, a newly discovered modulator of intestinal permeability, and its expression in coeliac disease [letter]. Lancet 355(9214):1518–1519, 2000
Hamilton I, Cobden I, Rothwell J, Axon AT: Intestinal permeability in coeliac disease: the response to gluten withdrawal and single-dose gluten challenge. Gut 23(3):202–210, 1982
Greco L, D’Adamo G, Truscelli A, Parrilli G, Mayer M, Budillon G: Intestinal permeability after single dose gluten challenge in coeliac disease. Arch Dis Child 66(7):870–872, 1991
Leke L, Barau E, Barbet JP, Epelbaum S, Vierin Y, Dupont C: [Value of the intestinal permeability test with lactulose-mannitol for screening and monitoring of celiac disease in children]. Arch Fr Pediatr 49(1):33–37, 1992
Catassi C, Rossini M, Ratsch IM, et al.: Dose dependent effects of protracted ingestion of small amounts of gliadin in coeliac disease children: a clinical and jejunal morphometric study. Gut 34(11):1515–1519, 1993
Fernandez-Calle P, Codoceo R, Polanco I, Gomez-Cerezo J, Orsi M, Tenias JM: Is an intestinal permeability test a valid marker for slight dietary transgressions in adolescents with coeliac disease? Gut 34(6):774–777, 1993
Bonamico M, Ballati G, Mariani P, et al.: Screening for coeliac disease: the meaning of low titers of anti-gliadin antibodies (AGA) in non-coeliac children. Eur J Epidemiol 13(1):55–59, 1997
Dieterich W, Esslinger B, Schuppan D: Pathomechanisms in celiac disease. Int Arch Allergy Immunol 132(2):98–108, 2003
Dewar D, Pereira SP, Ciclitira PJ: The pathogenesis of coeliac disease. Int J Biochem Cell Biol 36(1):17–24, 2004
Clemente MG, De Virgiliis S, Kang JS, et al.: Early effects of gliadin on enterocyte intracellular signalling involved in intestinal barrier function. Gut 52(2):218–223, 2003
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Duerksen, D.R., Wilhelm-Boyles, C. & Parry, D.M. Intestinal Permeability in Long-Term Follow-up of Patients with Celiac Disease on a Gluten-Free Diet. Dig Dis Sci 50, 785–790 (2005). https://doi.org/10.1007/s10620-005-2574-0
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s10620-005-2574-0