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Gluten challenge test


The gluten challenge test (short: gluten challenge) is a medical test in which gluten-containing foods are consumed and (re-)occurrence of symptoms is observed afterwards to determine whether and how much a patient reacts to these foods. The test may be performed in patients with suspected gluten-related disorders in very specific occasions and under medical supervision, for example in people who had started a gluten-free diet without performing duodenal biopsy.

Gluten challenge is discouraged before the age of 5 years and during pubertal growth.

Gluten challenge protocols have significant limitations because a symptomatic relapse generally precedes the onset of a serological and histological relapse, and therefore becomes unacceptable for most patients.

Before serological and biopsy-based diagnosis of coeliac disease was available, a gluten challenge test was a prerequisite for diagnosis of coeliac disease.

Today, with serological testing (determination of coeliac disease specific antibodies in the blood) and duodenal biopsy with histological testing being available for diagnosing coeliac disease, patients with suspected coeliac disease are strongly advised to undergo both serological and biopsy testing before undertaking a gluten-free diet. People who present minor damage of the small intestine often have negative blood antibodies titers and many patients with coeliac disease are missed when duodenal biopsy is not performed. Serologic tests have high capacity to detect coeliac disease only in patients with total villous atrophy and have very low capacity to detect cases with partial villous atrophy or minor intestinal lesions with normal villi. Currently, gluten challenge is no longer required to confirm the diagnosis in patients with intestinal lesions compatible with coeliac disease and a positive response to a gluten-free diet. Nevertheless, in some cases, a gluten challenge with a subsequent biopsy may be useful to support the diagnosis, for example in people with a high suspicion for coeliac disease, without a biopsy confirmation, who have negative blood antibodies and are already on a gluten-free diet. Gluten challenge is discouraged before the age of 5 years and during pubertal growth. European guidelines suggest that in children and adolescents with symptoms which are compatible with coeliac disease, the diagnosis can be made without the need for intestinal biopsy if anti-tTG antibodies titres are very high (10 times the upper limit of normal).


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