Confirming persistence of gluten intolerance in children diagnosed as having coeliac disease in infancy. Usefulness of one hour blood xylose test

Abstract

In young infants, the clinical and investigative features of coeliac disease (CD) may be mimicked by other conditions such as cow's milk intolerance or secondary disaccharidase deficiency. It is therefore especially important to confirm a diagnosis of CD by later gluten challenge in such infants. 16 Children in whom the diagnosis of CD had been made before the age of 12 mth had an oral gluten challenge, after being treated with a gluten free diet for periods of one mth to 5 yr. In 15, intestinal xylose malabsorption was demonstrated by the 1 hr blood xylose level within 1 to 28 days of starting ingestion of gluten. One child, with a persistently normal one hr blood xylose test after gluten challenge for 3 mth, had normal absorption and normal jejunal histology after 18 mth on a gluten containing diet; she is considered not to have CD. The one hr blood xylose test before and after gluten challenge can help to confirm the diagnosis in coeliac patients diagnosed in infancy.