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Pekka Collin University of Tampere Greenbelt, MD July 14, 2005

Explore gluten exposure in gluten-free diets, sensitivity variability in celiac patients, and impact on mucosal architecture. Retrospective data on wheat starch-based diets and oats in celiac disease.

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Pekka Collin University of Tampere Greenbelt, MD July 14, 2005

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  1. Pekka CollinUniversity of TampereGreenbelt, MD July 14, 2005 • Rationale of a retrospective analysis of gluten levels in gfd • Gluten exposure in gfd • Variability of sensitivity to gluten in celiac disease patients –Northern European view

  2. Gluten-free diet n=52Kaukinen et al Scand J Gastroenterol 1999;34:163 Naturally gfd Dietary lapses Wheat starch gfd

  3. Intolerance to cereals Kaukinen et al Scand J Gastroenterol 2000;35:942-6 Celiac disese Wheat allergy N=88 IBS (?)

  4. Long-term GFD CD children CD adults DH adults CD adults, occasional gluten Short-term GFD CD adults Untreated CD adults 0 1.0 5.0 3.0 4.0 2.0 Villous height / crypt depth ratio Kaukinen et al 1999

  5. 200 Collin et al Aliment Pharmacol Ther 2004;19:1277-83 180 160 140 120 100 Gluten content (ppm) 80 60 40 20 10 <10 Naturally gluten-free flours Wheat-starch- based gluten-free flours

  6. Consumption of floursCollin et al Aliment Pharmac Ther 2004

  7. Gluten content in products, ppm (=mg/kg) Amount of daily gluten-free foods 50g 100g 200g 300g Amount of daily gluten ingestion 200 10mg 20mg 40mg 60mg 100 5mg 10mg 20mg 30mg 50 2.5mg 5mg 10mg 15mg 20 1mg 2mg 4mg 6mg

  8. Recovery of small bowel mucosa Long GFD ShortGFD Lapses GFD USA Finland

  9. Villous height / crypt depth Peräaho et al Aliment Pharmacol Ther 2003;17:587-94 4.0 3.0 2.0 1.0 0 I II I II Naturally GFD Wheat starch- based GFD

  10. IELs /100 enterocytes Peräaho et al Aliment Pharmacol Ther 2003;17:587-94 80 60 40 20 10 I II I II Naturally GFD Wheat starch- based GFD

  11. How coeliac disease patients consent to include oats in their gluten-free diet

  12. The use of oatsn=1000 (710 responded) Never used Stopped Taking currenly

  13. Oats and quality of lifePeräaho et alScand J Gastroenterol 2004;39:27-31 • Randomized study, gfd with and without oats; 1 year; n=39 • No difference in quality of life • Patients taking oats suffered more often from diarrhea • Mucosal architecture similar, more IELs in the oat-group

  14. Conclusions (’Northern European view’) • Trace amount of residual gluten are well tolerated (100 ppm) • A good dietary compliance is essential • The majority of celiac disease patients appreciate oat products

  15. +++++++ Janatuinen 1995 Shrinivasan. 1996 Shrinivasan 1999 Janatuinen 2000 Janatuinen 2001 Hardman 1998 Reunala 1998 Hoffenberg 2000 Holm 2000 Picarelli 2001 Kilmartin 2001 +++++++ Högberg 2004 Störsrud 2002 - - - - - - - - Lundin 2003 Arentz-Hansen 2003 Are oats safe?

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