Research Article

Humoral response to wheat protein in patients with coeliac disease and enteropathy associated T cell lymphoma.

BMJ 1986; 293 doi: http://dx.doi.org/10.1136/bmj.293.6552.908 (Published 11 October 1986) Cite this as: BMJ 1986;293:908
  1. C O'Farrelly,
  2. C Feighery,
  3. D S O'Briain,
  4. F Stevens,
  5. C E Connolly,
  6. C McCarthy,
  7. D G Weir

    Abstract

    Features that might distinguish uncomplicated coeliac disease from enteropathy associated T cell lymphoma were investigated. Of 76 patients with coeliac disease, 71 (93%) had raised levels of alpha gliadin antibody and all responded clinically and histologically to treatment with a gluten free diet. In contrast, none of 16 patients with enteropathy associated T cell lymphoma had raised levels of alpha gliadin antibody, and treatment with a gluten free diet resulted in histological improvement in one and transient clinical improvement in six patients. The ratio of women to men was 2.2:1 in the group with coeliac disease and 1:1.6 in the patients with enteropathy associated T cell lymphoma. Thus patients with enteropathy associated T cell lymphoma do not display a humoral immune response to wheat protein (alpha gliadin), rarely respond to a gluten free diet, and are often men. Patients with uncomplicated coeliac disease usually have raised levels of alpha gliadin antibody, always respond to a gluten free diet, and are frequently women. These findings suggest the presence of two separate forms of enteropathy: one is benign and sensitive to wheat protein whereas the other runs a malignant course.