CHANGES IN INTESTINAL PERMEABILITY RELATED TO GLUTEN (G) INGESTION IN CHILDREN WITH CELIAC DISEASE (CD)

Abstract

Intestinal permeability to polyethylene glycol (PEG) (MW 238-590) and serum antigliadin antibody levels (AGA) were studied in children with CD, diagnosed according to ESPGAN criteria. Results of intestinal permeability to PEG (obtained as described previously, NASPG/ESPGAN, 1985:80) were expressed as N_1/2, the theoretical polymer length whose recovery is 50% of the maximally recovered polymer (normal > 12). At diagnosis, 0/9 children had normal N_1/2 and AGA. Twenty-four/28 children on a G-free diet had normal N_1/2. Two children with abnormal N_1/2 admitted ingesting G; one had abnormal N_1/2 at 56 d but normal after 180 d. Only 5 had normal AGA. After 30 d on a G-free diet, 7/8 children had normal N_1/2; but none had normal AGA. After 77 d on the diet, 12/14 had normal N_1/2; only 3 had normal AGA. Upon reintroduction of G, N_1/2 were abnormal in 17/36 with a tendency towards normal levels with longer re-exposure, although small bowel biopsies were abnormal. Regression analysis between N_1/2 and duration of re-exposure to G indicated a significant association (r=0.5, P < 0.05); for every day of re-exposure, N_1/2 improved by 0.006 units. Conclusion: Intestinal permeability rapidly improves with elimination of G from the diet and PEG serves as a good indicator to detect children who are noncompliant. In addition, an apparent adaptation of the bowel occurs with prolonged re-exposure to G, and while histological changes persist and AGA remain elevated, intestinal permeability tends to improve.

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