Effects of small amounts of gluten in the diet of coeliac patients.

A diet excluding wheat, oats, rye and barley is the cornerstone of the treatment of coeliac patients. Such a gluten-free diet (GFD) is recommended irrespective of the presence of symptoms. Maintenance of a strict GFD is not a simple matter, as small amounts of gluten capable of causing relapse have been identified in several previously unsuspected sources, thanks to the recent availability of sensitive detection assays. To date there is no definition as to what amount of gluten in the diet might be tolerable. Compliance to the GFD is a problem, particularly in certain groups of patients (e.g. adolescents). Small amounts of gluten in the diet often do not cause clinical symptoms, nor increased serum levels of antigliadin antibody, nor gross changes of the jejunal histology; nevertheless, they seem to be able to activate mucosal cell-mediated immunity. This finding represents a warning in view of the recently reported protective effect of GFD against malignancies. In conclusion, all present evidences give strong support for advising all patients to adhere to a strict GFD for life.