Gluten reintroduction

To differentiate the constituent members of the sprue group, it is necessary to consider 2 effects. First, the effect of a wheat gluten-free diet and second, the effects of reintroduction of gluten after a period of remission on a gluten-free regimen. 

The Effect of Reintroduction of Gluten into the Diet of Patients in Remission... 

The effect of reintroduction of gluten is readily demonstrated in patients who show complete recovery it is difficult to study, however, in those that do not return to normal. In the first group the reintroduction of wheat gluten or appropriate fractions has been shown to cause many effects including steatorrhea. The other effects of reintroduction of gluten will be discussed in detail later. 

The change in daily output of fecal fat forms the basis for the definitive diagnostic test for gluten induced enteropathy (F16, F21). This diagnosis is justified if the patient presented with the main features of the malabsorption syndrome, if the fecal fat output fell to normal levels on a gluten-free diet, and if subsequent reintroduction of gluten into the diet caused an unequivocal increase in fecal fat... 

As already mentioned, it is difficult to assess the effect of reintroduction of gluten into patients that are only partially recovered, since there are commonly large daily fluctuations in the fecal fat level. For the present it seems wise to retain the term idiopathic steatorrhea to cover these patients and to accept the view that they may exhibit varying degrees of gluten intolerance. 

The situation has recently been clarified considerably by the finding that the removal of wheat and rye flour from the diet of children with coeliac disease has resulted in rapid improvement, both clinically and biochem-ically, and that deterioration followed the reintroduction into the diet of wheat flour or wheat gluten, but wheat starch had no effect. As reported by Weyers, van de Kamer, and Dicke at the First International Congress on Dietetics at Amsterdam, the decisive factor is the protein gliadin. 

---