The timing of histological damage following a single challenge with gluten in treated coeliac disease.

Two treated subjects and one healthy volunteer have been challenged with a single dose of fraction B of gluten administered intraduodenally. Serial biopsy specimens were obtained by means of a Quinton hydraulically operated biopsy instrument immediately before challenge and repeatedly thereafter. The biopsy specimens were studied by light microscopy, electron microscopy, immunofluorescence, immunoperoxidase staining and disaccharidase assay. The two coeliac subjects showed pronounced mucosal changes which developed a few hours after challenge and which showed the features of an Arthus-type reaction. The healthy volunteer was unaffected. It is concluded that the lesion of coeliac disease is the result of an Arthus-type reaction induced by ingested gluten in susceptible subjects.