Current perspectives on returning gluten to the diet to test for coeliac disease; how much, how long?

Kim Faulkner-Hogg


Diagnosis of coeliac disease can be straight forward if the patient presents on a gluten containing diet; the process becomes more complex if gluten has been removed. How much gluten, what type of gluten and for how long should gluten be returned to the diet? These are questions that in Australia and internationally evoke a mixed bag of answers.  Doctors need to develop an understanding of the gluten content of the patients diet as not all gluten is equal in provoking disease. Wheat flour products are best used as a gluten challenge. Oats, wheat starch, malt, beer, wheat thickeners and wheat glucose syrups do not contain the quantities of gluten desired in a gluten challenge food. If insufficient gluten is in the diet, serogenetic tests to exclude coeliac disease can narrow down the group requiring gluten provocation. No one guideline can cover the spectrum of patient interpersonal sensitivities to returning gluten to the diet. To optimize the diagnosis of coeliac disease, Leffler’s shorter two week ingestion of two slices of bread each day, followed by coeliac specific serology taken at week four, may be utilised in a symptomatic wheat-sensitive subgroup of patients. The conventional challenge of 4 slices of bread each day for 6 weeks could also be reduced to at least 2 slices of bread each day for 6 weeks, for those who could push through symptoms for this time frame. Since the interpretation of the results is dependent on the presence of gluten, doctors should consider including gluten consumption information, in the test outcome reports.


coeliac disease; gluten; diagnose; diet

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