Fecal gluten immunogenic peptides as indicators of dietary compliance in celiac patients

Porcelli, Brunetta; Ferretti, Fabio; Cinci, Francesca; Biviano, Ivano; Santini, A.; Grande, Elisabetta; Quagliarella, Francesco; Terzuoli, Lucia; Bacarelli, Maria Romana; Bizzaro, Nicola; Marini, Mario

doi:10.23736/s1121-421x.20.02662-8

Cited by 17 publications

(16 citation statements)

References 20 publications

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“…In our study, the main advantage of Liaison anti-tTG assay was the absence of false positives, as the two patients with positive concentrations had mucosal damage, while positive results in Quanta Flash assay were associated with lower adherence to a GFD measured by the CDAT questionnaire. In contrast, no association was observed between serum anti-tTG IgA concentrations and GIP results as also reported in previous studies [20,39], although others did find agreement between the two tests [40].…”

Section: Discussionsupporting

confidence: 61%

Poor Sensitivity of Fecal Gluten Immunogenic Peptides and Serum Antibodies to Detect Duodenal Mucosal Damage in Celiac Disease Monitoring

et al. 2020

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A lifelong gluten-free diet (GFD) is the only current treatment for celiac disease (CD), but strict compliance is complicated. Duodenal biopsies are the “gold standard” method for diagnosing CD, but they are not generally recommended for disease monitoring. We evaluated the sensitivity and specificity of fecal gluten immunogenic peptides (GIPs) to detect duodenal lesions in CD patients on a GFD and compared them with serum anti-tissue transglutaminase (tTG) IgA antibodies. A prospective study was conducted at two tertiary centers in Spain on a consecutive series of adolescents and adults with CD who maintained a long-lasting GFD. Adherence to a GFD and health-related quality of life were scored with validated questionnaires. Mucosal damage graded according to the Marsh–Oberhüber classification (Marsh 1/2/3) was used as the reference standard. Of the 97 patients included, 27 presented duodenal mucosal damage and 70 had normal biopsies (Marsh 0). The sensitivity (33%) and specificity (81%) of GIPs were similar to those provided by the two assays used to measure anti-tTG antibodies. Scores in questionnaires showed no association with GIP, but an association between GIPs and patients’ self-reported gluten consumption was found (p = 0.003). GIP displayed low sensitivity but acceptable specificity for the detection of mucosal damage in CD.

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Section: Discussionsupporting

confidence: 61%

Poor Sensitivity of Fecal Gluten Immunogenic Peptides and Serum Antibodies to Detect Duodenal Mucosal Damage in Celiac Disease Monitoring

et al. 2020

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“…A small fraction of ingested gluten peptides is either adsorbed and excreted in urine or excreted in stools, thereby revealing ongoing gluten exposure. Fecal GIP positivity has been found in 16%–30% of treated patients with CD ( 8 , 10 , 12 , 13 ). In a systematic review, the GIP assay showed the lowest celiac dietary adherence rate (75%) in children with CD on a GFD as compared with the intestinal biopsy (87%), self-report (81%), structured dietary interview (77%), and CD serological markers (76%), suggesting that this test is more sensitive than other methods of GFD monitoring ( 6 ).…”

Section: Discussionmentioning

confidence: 99%

Determination of Urinary Gluten Immunogenic Peptides to Assess Adherence to the Gluten-Free Diet: A Randomized, Double-Blind, Controlled Study

Monachesi

Verma

Catassi

et al. 2021

Clin Transl Gastroenterol

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INTRODUCTION: The adherence to a gluten-free diet (GFD) is a trending topic in the management of celiac disease. The aim of our study was to evaluate the diagnostic performance of urinary gluten immunogenic peptides (GIP) determination to detect gluten contamination of the GFD. METHODS: In study A, 25 healthy adults on a standard GFD performed 6 gluten challenges (0, 10, 50, 100, 500, and 1,000 mg) with quantification of urinary GIP before (T 0 ) and during the following 24 hours. In study B, 12 participants on a gluten contamination elimination diet underwent urinary GIP determination at T 0 and after challenge with 5 or 10 mg gluten. Urine GIP concentration was determined by an immunochromatographic assay. RESULTS: In study A, 51 of 150 baseline urine samples were GIP+ on GFD and 7 of 17 were GIP+ after the zero-gluten challenge, whereas only 55 of 81 were GIP+ after the 10–1,000 mg gluten challenges. There was no significant change in the 24-hour urinary GIP when increasing gluten from 10 to 1,000 mg. In study B, 24 of 24 baseline urine samples were GIP−, whereas 8 of 24 were GIP+ after 5 or 10 mg of gluten. DISCUSSION: Traces of gluten in the standard GFD may cause positivity of urinary GIP determination, whereas a false negativity is common after a gluten intake of 10–1,000 mg. Owing to the impossibility of standardizing the test in normal conditions, it seems unlikely that urinary GIP determination may represent a reliable tool to assess the compliance to the GFD of patients with celiac disease or other gluten-related disorders.

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“…Stool Children Case-control study [87] Cohort study [96] Prospective study [89] Transversal study [97] Systematic revision [98] Prospective study [99] Observational descriptive study [100] Children and adults Prospective study [88] Transversal study [101,102] Adults Observational prospective study [103] Prospective study [104] Prospective study [105] Urine Children and adults Controlled study [106] Randomized controlled study [90] Adults Transversal study [107] Prospective study [108] Prospective study [109] Prospective study [110] Stool and urine Children and adults Meta-analysis [111] Adults Prospective study [80] Prospective study [1 7, 7 7 ] Prospective study [112] Table 2.…”

Section: Study Design Referencesmentioning

confidence: 99%

Celiac Disease, Management, and Follow-Up

Ruiz-Carnicer¹,

Segura²,

Sousa³

et al. 2022

Immunology of the GI Tract - Recent Advances

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Celiac disease (CD) is a systemic immune-mediated disorder characterized by a specific serological and histological profile triggered by gluten ingestion, which is given in genetically predisposed subjects. Heterogeneous clinical presentation is characteristic in CD, affecting any organ or tissue with gastrointestinal, extraintestinal, seronegative, or nonresponsive manifestations. CD diagnosis is based on several criteria, including genetic and serological tests, clinical symptoms and/or risk conditions, and duodenal biopsy. Currently, the available treatment for CD is a strict gluten-free diet (GFD) that essentially relies on the consumption of naturally gluten-free foods, such as animal-based products, fruits, vegetables, legumes, and nuts, as well as gluten-free dietary products that may not contain more than 20 mg of gluten per kg of food according to Codex Alimentarius. However, it is difficult to maintain a strict oral diet for life and at least one-third of patients with CD are exposed to gluten. Difficulties adhering to a GFD have led to new tools to monitor the correct adherence to GFD and alternative forms of treatment.

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Fecal gluten immunogenic peptides as indicators of dietary compliance in celiac patients

Cited by 17 publications

References 20 publications

Poor Sensitivity of Fecal Gluten Immunogenic Peptides and Serum Antibodies to Detect Duodenal Mucosal Damage in Celiac Disease Monitoring

Poor Sensitivity of Fecal Gluten Immunogenic Peptides and Serum Antibodies to Detect Duodenal Mucosal Damage in Celiac Disease Monitoring

Determination of Urinary Gluten Immunogenic Peptides to Assess Adherence to the Gluten-Free Diet: A Randomized, Double-Blind, Controlled Study

Celiac Disease, Management, and Follow-Up

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