Canadian Journal of Gastroenterology and Hepatology / 2016 / Article / Tab 1

Review Article

Celiac Disease and Gluten-Free Oats: A Canadian Position Based on a Literature Review

Table 1

Clinical studies of the effects of oats on children with celiac disease from January 2008 to January 2015.

Reference authors, year of publicationNumber of subjects testedOats exposureAmount of oatsLab testsBiopsyDrop-out rateConclusion

Koskinen et al., 2009, Finland [18]
13 in remission with open oats challenge; 10 in remission wheat, rye, barley, and oats
2 years50 g/dayTTG IgASmall-bowel biopsies (IgA deposits) at baseline + 6 m + 24 m: No signs of immune activation or relapse of CD
No detrimental effect on intestinal mucosal villous morphology and IEL density
2 children experienced abdominal pain but with normal biopsyPure oats can be safely added to the GFD of children with CD

Gatti et al., 2013, Italy [19]
Group A-B = 154
Group B-A = 152
15 months [6 months oats or placebo (A-B); 3 months washed-out; 6 months oats or placebo (B-A)]Up to 40 g/dayTTG IgA, antigliadin IgG, and antiavenin AbsNo biopsy55/154 (36%) enrolled in group A-B and 42/152 (28%) enrolled in group B-A No information provided about reasons for withdrawalsAddition of noncontaminated oats in the treatment of children with CD does not cause changes in intestinal permeability and gastrointestinal symptoms

Tapsas et al., 2014, Sweden [20]
282 (89%) consumed oats and 259 (82%) pure oats
34 (11%) did not consumed oats
Mean = 6.9 yearsNot specifiedNo serologyNo biopsy34 (11%) did not consume oats. For those having tried oats () but stopped, 8 did not like the taste, 2 reported abdominal pain and loose stools, 2 gave no specific reason, and 1 did not answerMost patients did not report adverse effects after long-term consumption of oats

Sjöberg et al., 2014
(Same patients as for study published in 2004 by Högberg et al. [16]), Sweden [28]

15 GFD with uncontaminated oats (GFD-oats)
versus 13 GFD without oats (GFD-std)
Mean = 13 monthsMedian = 20 g/day
Range = 3–43 g/day
TTG IgA, antigliadin IgG
Expression levels of mRNAs for 22 different immune effector molecules and tight junctions proteins (markers of mucosal inflammation)
No difference between 2 groups in intestinal histology score (Marsh score)No difference between 2 groups in terms of serology biomarkers and intestinal histology score
Normalisation of genetic markers of regulators of inflammation in some pediatric patients with CD maybe significantly reduced in the GFD-oats group compared to the GFD-std group
Altered functions of the epithelium in the small intestine mucosa “support the notion that a fraction of CD patients tolerate oats poorly”

Tjellström et al., 2014
(Same patients as for study published in 2004 by Högberg et al. [16]), Sweden [29]

34 GFD with uncontaminated oats (GFD-oats)
versus 37 GFD without oats (GFD-std)
12 months25–50 g/dayEndomysial IgA and IgG, antigliadin IgA, and TTG IgA
Faecal short chain fatty acids (SCFA) concentration (marker of gut microflora metabolism) and SCFA fermentation index (marker of intestinal inflammation)
At baseline: small bowel enteropathy consistent with CD; at 12 months: all children in clinical remission except one child (GFD-std group) who did not undergo a control biopsy None
However, all children in the study did not deliver faecal samples and some samples were too small to permit analysis; distribution of missing samples was evenly distributed between the 2 study groups
Normalisation of small bowel mucosal architecture and decreasing celiac serology markers However, total SCFA remained at a high level in the GFD-oats group compared to the GFD-std group

Abs: antibodies; CD: celiac disease; GFD: gluten-free diet; IEL: intraepithelial lymphocytes; IgA: immunoglobulin A; IgG: immunoglobulin G; TTG: tissue transglutaminase; GFD-std: standard GFD without oats; GFD-oats: GFD with uncontaminated oats.