Adverse effects of dietary gluten in four patients with regional enteritis

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Abstract
Four patients with regional enteritis, and eight control subjects without gastrointestinal disease, were observed for 12 days while they were on a gluten-free diet. Gluten was then added to the diet in a dose of 5 to 20 g for 12 days (or less, in the case of two of the enteritis cases). One of the enteritis patients was tested twice in this way. In the control subjects the number, weight and fat content of the stools were not influenced by gluten, the stools remained guaiac-negative, and the patients reported no digestive symptoms. In contrast, adverse effects were observed in all four enteritis subjects. Case #1 developed melena, fever, and increased abdominal discomfort within 9 days of gluten administration. Case #2, after 8 days of gluten, developed melena, steatorrhea, increased diarrhea, and abdominal discomfort. Case #3 on the 5th day of gluten developed tarry, guaiac-positive stools, fever, nausea, and vomiting, steatorrhea and increased abdominal pain. Case #4, in both of two trials, experienced a 100% increase in the magnitude of steatorrhea, evident during the first 4 days of gluten; in one trial, the stools became guaiac-positive after 8 days of gluten. In all cases, these adverse effects subsided gradually within 2 to 4 weeks after gluten was discontinued.