Correspondence

Oats in Celiac Disease

N Engl J Med 1996; 334:865-866March 28, 1996

Article

To the Editor:

In a study of up to 12 months' duration, Janatuinen et al. (Oct. 19 issue),1 found that moderate amounts of oats can be included in a gluten-free diet without adverse effects in most adults with celiac disease. We do not agree that specimens from endoscopic proximal duodenal biopsies are representative of jejunal mucosa, since these villi are shorter and broader than the jejunal villi.2

In addition, a clinical or morphologic study should include immunologic data, in the form of either serum antibody titers to gluten or small intestinal mucosal variables indicative of antigenic damage. It would have been useful to perform the anti-endomesial or antigliadin antibody test for the detection of serum antibodies to gliadin before and at the end of the study.

As for the advisability of adding oats to a gluten-free diet, we believe that a study of up to 12 months is not long enough. The incidence of cancer in patients with celiac disease is markedly increased3 and is related to the intake of gluten and its prolamins, even in small quantities. Holmes et al.3 demonstrated that a gluten-free diet for at least five years significantly decreased the incidence of cancer.

For these reasons, we believe that a definite recommendation for the addition of even moderate amounts of oats to a gluten-free diet is premature.

David Branski, M.D.
Margot Shine, M.D.
Shaare Zedek Medical Center, Jerusalem 91031, Israel

3 References

1. 1

   Janatuinen EK, Pikkarainen PH, Kemppainen TA, et al. A comparison of diets with and without oats in adults with celiac disease. N Engl J Med 1995;333:1033-1037
   Full Text | Web of Science | Medline

2. 2

   Sullivan PB, Phillips MB, Neale G. Endoscopic capsule biopsy of the small intestine. J Pediatr Gastroenterol Nutr 1988;7:544-547
   CrossRef | Web of Science | Medline

3. 3

   Holmes GK, Prior P, Lane MR, Pope D, Allan RN. Malignancy in coeliac disease -- effect of a gluten free diet. Gut 1989;30:333-338
   CrossRef | Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: Endoscopic proximal duodenal biopsies performed by forceps near the ligament of Treitz have been compared with suction biopsies in two studies.1,2 Both studies concluded that the endoscopic biopsies produced specimens that were as good as those produced by suction biopsies. Even if there had been minor differences between these techniques, they would have had no effect on the results, because the same method was used throughout the study.

Drs. Branski and Shine are correct in noting that the immunologic data are important in terms of antigenic damage. We have analyzed the data on antireticulin and antigliadin antibodies and serum IgA levels. The preliminary results indicate that there are no differences in these immunologic variables between the study groups.

We agree that a 12-month study may not be long enough. A five-year follow-up of the same patients is in progress.

Esko K. Janatuinen, M.D.
Risto J.K. Julkunen, M.D.
Matti J.U. Uusitupa, M.D.
University of Kuopio, SF-70210 Kuopio, Finland

2 References

1. 1

   Wilson IR, Oxner RB, Frampton CM, Tisch G, Chapman BA, Cook HB. Comparison of endoscopic forceps biopsies and capsule biopsies in determining disaccharidase activity in the duodenum. Gastrointest Endosc 1991;37:527-530
   CrossRef | Web of Science | Medline

2. 2

   Achkar E, Carey WD, Petras R, Sivak MV, Revta R. Comparison of suction capsule and endoscopic biopsy of small bowel mucosa. Gastrointest Endosc 1986;32:278-281
   CrossRef | Web of Science | Medline

Citing Articles (5)

Citing Articles

1. 1

   James Gregor, Michael Sai Lai Sey. 2010. Celiac Disease: Diagnosis, Treatment and Prognosis. , 200-210.
   CrossRef

2. 2

   Brian D. Cameron. (2002) Celiac Disease: Internet Resources. Health Care on the Internet 6:3, 23-32
   CrossRef

3. 3

   Eamonn S. Molloy, Sean F. Dinneen. (2000) 55-Year-Old Woman With Worsening Seizure Control. Mayo Clinic Proceedings 75:5, 529-532
   CrossRef

4. 4

   Eamonn S. Molloy, Sean F. Dinneen. (2000) 55-Year-Old Woman With Worsening Seizure Control. Mayo Clinic Proceedings 75:5, 529-532
   CrossRef

5. 5

   TRICIA THOMPSON. (1997) Do Oats Belong in a Gluten-Free Diet?. Journal of the American Dietetic Association 97:12, 1413-1416
   CrossRef