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Oats induced villous atrophy in coeliac disease

¹ Department of Medicine, Rikshospitalet, Oslo, Norway
² LIIPAT, Institute of Pathology, Rikshospitalet and University of Oslo, Oslo, Norway
³ Department of Pathology, Rikshospitalet, Oslo, Norway
⁴ Department of Pathology, Ullevaal University Hospital, Oslo, Norway
⁵ Department of Medicine, Ullevaal University Hospital, Oslo, Norway
⁶ Institute for Medical Research, Rikshospitalet and University of Oslo, Oslo, Norway
⁷ Department of Medicine, Lovisenberg Hospital, Oslo, Norway
⁸ Unidad de Analisis Estructural Proteinas, Centro Nacional de Biotechnologica, CSIC, Madrid, Spain

Correspondence to:
Correspondence to:
Dr K E A Lundin
Department of Medicine, Rikshospitalet, N-0027 Oslo, Norway; knut.lundin{at}rikshospitalet.no

ABSTRACT
The current trend is to allow coeliac disease (CD) patients to introduce oats to their gluten free diet. We sought further data from the clinical setting with regards to oats consumption by coeliac patients. Several oat products were tested for wheat contamination using a commercial enzyme linked immunoassay (ELISA) kit, and six samples were examined by an ELISA using a cocktail of monoclonal antibodies, mass spectrometry, and western blot analysis. Nineteen adult CD patients on a gluten free diet were challenged with 50 g of oats per day for 12 weeks. Serological testing and gastroduodenoscopy was performed before and after the challenge. Biopsies were scored histologically and levels of mRNA specific for interferon were determined by reverse transcription-polymerase chain reaction analysis. Oats were well tolerated by most patients but several reported initial abdominal discomfort and bloating. One of the patients developed partial villous atrophy and a rash during the first oats challenge. She subsequently improved on an oats free diet but developed subtotal villous atrophy and dramatic dermatitis during a second challenge. Five of the patients showed positive levels of interferon mRNA after challenge. Some concerns therefore remain with respect to the safety of oats for coeliacs.

Keywords: coeliac disease; oats; clinical challenge; inflammation; villous atrophy

Abbreviations: CD, coeliac disease; ELISA, enzyme linked immunoassay; RNA, ribonucleic acid; RT-PCR, reverse transcription-polymerase chain reaction; IFN-, interferon ; ppm, parts per million; MS, mass spectrometry; AGA, antigliadin antibodies; tTG, tissue transglutaminase; EMA, antiendomysium antibodies

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