Research on Celiac Disease in children

Dr. Philip Butzner has been researching on Celiac Disease from as early as 1981. He defined Celiac Disease(CD) as a permanent intolerance to the ingestion of gluten characterized by inflammatory enteropathy and malabsorption (villus atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes).

The article that was recently published by Dr. Butzner discussed CD & Type I diabetes in children. Dr. Butzner conducted a study to assess IGA-EMA as a screening test for CD in children with IDDM (Insulin Dependent Diabetes Mellitus, also called Type I Diabetes). The earliest tests that were available for the diagnosis of CD were limited to the biopsy. Then in the mid-80's in Europe and about 1995 in the U.S., serological screening became available. However, the gold standard for diagnosing CD remains the small intestine biopsy. Blood samples from 236 known diabetics (1-18 years in age) were tested for total IGA and IGA-EMA by immunofluorescence. Of the 17 that had positive blood tests, 12 were subsequently diagnosed with CD. This is a prevalence of about 5%, which is far higher than the prevalence of CD in the general population. Also blood screening, particularly IGA-EMA (anti-endomysial antibody), demonstrated an association between CD and IDDM of 1 to 4% whereas it was only 0.02% in the general population. The results indicated that all Type I diabetic children should be screened for CD. He also noted that there was significant risks if diabetes and CD are left untreated, such as delayed puberty, growth failure, osteopenia, osteomalacia, anemia and/or gastrointestinal lymphoma.

Dr. Butzner also discussed the effect of oats on children with CD. He stated that his clinical experience has shown that 40% of celiac children cheat on their GF diets and hence the study on celiac children and oats. The aim of the study was to determine the safety of adding a moderate amount of commercially-available oats to the diet of celiac children. Quaker Oats provided their standard product for the study as there were no GF oats available in the market. 14 children, aged 8 to 16, with normal growth and no abnormalities, consumed oats 25 days per month. They were given 1 gram (gm) of oats for each kilogram (kg) of body weight per day, up to a maximum of 50 gm/day. The clinic followed up by telephone at 1, 3, 6, and 9 months and with blood testing and biopsy at one year. None of the children displayed any symptoms during the year. After one year, one child had elevated blood readings but a normal biopsy. Also, after one year, one child who displayed blunted villi was determined to have been consuming other grains. When the child returned to oats only, the blood antibodies returned to normal in 3 months.

The conclusions that were drawn by Dr. Butzner from his research were:

1. Commercially available oats are OK for celiac children to consume daily for one year.
2. IGA-EMA testing is a sensitive method of monitoring dietary compliance.
3. The quality of antibody testing must be improved so as to be equivalent anywhere.
4. More food testing is needed and standards have to be established.
5. A safe source of oats should be available. To date there have been no failures in two adult CD studies, two adult dermatitis herpetiformis studies and now two children CD studies with oats.