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Coeliac disease and gluten-free diet: a following-up study of fifteen young adults.

Fifteen patients with coeliac disease diagnosed in infancy and early childhood between 1959 and 1971 were included in the study. The primary diagnosis was made on the basis of typical symptoms and signs, stool examination for fat, xylose test and clinical and laboratory improvement after introduction of gluten-free diet. All patients were challenged with gluten for a minimum of 4 weeks to 4 years before a peroral proximal jejunal biopsy was performed between 1973 and 1976. The biopsy specimen showed changes consistent with coeliac disease in all patients. Gluten-free diet induced again clinical recovery and was recommended as a life-long diet. The patients were reinvestigated after 15-18 years (mean 17 years) and 13 biopsies were evaluated. Five of these biopsy specimens showed variable histopathological changes. Only 5 patients were still on a strict gluten-free diet. There was no correlation between the presence of gastro-intestinal symptoms and abnormal biopsies. All patients had haematological tests within the normal range. Anti-gliadin IgA levels above the upper normal limit were found in 2 out of 3 patients with grade IV histopathological changes in the mucosa, and in 1 of the patients on a normal diet who refused to have a biopsy performed. The patients' knowledge of their disease was evaluated, and suitable follow-up programs for coeliac patients are discussed.