Detection and quantification of gluten immunogenic peptides in feces of infants and their relationship with diet

Roca, María; Donat, Ester; Masip, Etna; Escobar, Paula Crespo; Fornés-Ferrer, Victoria; Polo, Begoña; Ribes-Koninckx, Carmen

doi:10.17235/reed.2018.5549/2018

Cited by 9 publications

(15 citation statements)

References 22 publications

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“…Regarding which method is more appropriate, Roca et al [ 43 , 67 ] proposed GIP testing of fecal samples as a non-invasive method that allows patient empowerment for self-managing the disease. ELISA is to be used for the laboratory quantification of GIP, while LFIA strips should be used for patient self-control following suspected involuntary infringements.…”

Section: Discussionmentioning

confidence: 99%

Determination of gluten immunogenic peptides for the management of the treatment adherence of celiac disease: A systematic review

Coto¹,

Mendía²,

Sousa³

et al. 2021

WJG

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BACKGROUND Gluten is a complex mixture of proteins with immunogenic peptide sequences triggering the autoimmune activity in patients with celiac disease (CeD). Gluten immunogenic peptides (GIP) are resistant to gastrointestinal digestion and are then excreted via the stool and urine. Most common detection methods applied in the follow-up visits for CeD patients such as serology tests, dietetic interviews, questionnaires, and duodenal biopsy have been proved to be inefficient, invasive, or inaccurate for evaluating gluten-free diet (GFD) compliance. Determination of excreted GIP in stool and urine has been developed as a non-invasive, direct, and specific test for GFD monitoring. AIM To summarize published literature about the clinical utility of GIP determination in comparison to the tools employed for GFD monitoring. METHODS PubMed and Web of Science searches were performed using the keywords “gluten immunogenic peptides” or “gluten immunogenic peptide” and a combination of the previous terms with “feces”, “stools”, “urine”, “celiac disease”, “gluten-free diet”, and “adherence” to identify relevant clinical studies published in English and Spanish between 2012 to January 2021. Reference lists from the articles were reviewed to identify additional pertinent articles. Published articles and abstracts reporting the clinical use of GIP determination in stool and/or urine for the follow-up of patients with CeD in comparison with other tools in use were included. Case reports, commentaries, reviews, conference papers, letters, and publications that did not focus on the aims of this review were excluded. RESULTS Total of 15 publications were found that involved the use of GIP determination in stool and/or urine to monitor the adherence to the GFD in comparison to other tools. Studies included both children and adults diagnosed with CeD and healthy volunteers. Overall, these preliminary studies indicated that this novel technique was highly sensitive for the detection of GFD transgressions and therefore could facilitate the follow-up of patients with CeD. Tools identified in this work included the CeD-specific serology, dietetic questionnaires, symptomatology, and the duodenal biopsy. Review of the literature revealed that the rates of GFD adherence may vary between 30%-93% using either stool or urine GIP determination, 49%-96% by the serology, 59%-94% using the dietetic questionnaires, 56%-95% by the reported symptoms and 44%-76% with the duodenal biopsy. In addition, the association between the different methods and histological abnormalities (Marsh II-III) was found to be 33%-100% for GIP determination (stool and urine), 25%-39% for CeD-specific serology, 3%-50% for dietetic questionnaires, and 22%-28% for the symptomatology. CONCLUSION Excreted GIP detection is the precise approach for determining voluntary or involuntary gluten consumption in CeD patients pr...

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Section: Discussionmentioning

confidence: 99%

Determination of gluten immunogenic peptides for the management of the treatment adherence of celiac disease: A systematic review

Coto¹,

Mendía²,

Sousa³

et al. 2021

WJG

View full text Add to dashboard Cite

show abstract

“…If a GFD is followed strictly, there are no fecal GIPs, while on the other hand when they can be detected it means that there has been gluten intake. Preliminary studies have shown that GIPs can be assayed with a sensitivity of 98.5% and a specificity of 100% [ 7 , 13 ]. For this reason, detection of fecal GIPs has been proposed as an effective, noninvasive method of assessing the dietary compliance of celiac patients [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Testing for fecal gluten immunogenic peptides: a useful tool to evaluate compliance with gluten-free diet by celiacs

Porcelli

Ferretti

Biviano

et al. 2020

aog

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Background Although experts agree that strict dietary compliance is fundamental for the health of celiac patients, there are no evidence-based recommendations on the best way to assess dietary compliance. Detection of gluten immunogenic peptides (GIPs) in feces was recently proposed as an effective method of assessing the dietary compliance of celiac patients. Methods Fifty-five consecutive celiac patients (27 adults and 28 children, age 6-72 years), who had been on a gluten-free diet for at least 2 years, were enrolled. All patients were evaluated clinically for symptoms, physical parameters and laboratory parameters. Dietary compliance was assessed with the Biagi questionnaire and serum anti-tissue transglutaminase (tTG) IgA antibodies were measured. GIPs were determined by immunoenzymatic assay on an automated Chorus analyzer (DIESSE Diagnostica Senese), after extraction of fecal samples by the method developed by DIESSE. Results Eight patients tested positive for GIPs (GIPs+); 71.4% of GIP-positive patients were asymptomatic; tTG antibodies were detected in 3/8 GIP+ patients. The Biagi score was significantly associated with fecal positivity for GIPs (P=0.02). However, according to the Biagi score, 57.1% of GIP+ patients followed the diet strictly and 5.4% of GIP- subjects did not comply with the diet or made substantial mistakes. Conclusions Assay of fecal GIPs identified more patients who did not comply with the diet than did the Biagi questionnaire, evaluation of symptoms or anti-tTG antibodies. Detection of fecal GIPs offers a direct, objective, quantitative assessment of even occasional exposure to gluten and is confirmed as a practical way to check dietary compliance.

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“…GIP, analyzed in stools and urine by using commercial ELISAs (monoclonal antibodies G12 and/or A1), have been proposed as new non-invasive biomarkers to detect gluten intake and to verify GFD compliance in patients with CD [ 45 , 46 , 49 , 80 , 81 , 82 , 83 , 84 , 85 ]. GIP are resistant to gastrointestinal digestion and responsible for immunogenic reactions in the T cells of patients with CD [ 83 ].…”

Section: Adherence To a Gfdmentioning

confidence: 99%

“…To compare the sensitivity and specificity of a rapid lateral flow technique (LFT) based on G12 and A1 monoclonal antibodies with the G12 ELISA method, stool samples from 54 healthy infants divided into two groups were analyzed [ 85 ]. Group 1 included infants aged 6 to 24 months, with an unrestricted consumption of gluten-containing cereals.…”

Section: Adherence To a Gfdmentioning

confidence: 99%

Challenges of Monitoring the Gluten-Free Diet Adherence in the Management and Follow-Up of Patients with Celiac Disease

et al. 2021

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Celiac disease (CD) is a chronic gluten-responsive immune mediated enteropathy and is treated with a gluten-free diet (GFD). However, a strict diet for life is not easy due to the ubiquitous nature of gluten. This review aims at examining available evidence on the degree of adherence to a GFD, the methods to assess it, and the barriers to its implementation. The methods for monitoring the adherence to a GFD are comprised of a dietary questionnaire, celiac serology, or clinical symptoms; however, none of these methods generate either a direct or an accurate measure of dietary adherence. A promising advancement is the development of tests that measure gluten immunogenic peptides in stools and urine. Causes of adherence/non-adherence to a GFD are numerous and multifactorial. Inadvertent dietary non-adherence is more frequent than intentional non-adherence. Cross-contamination of gluten-free products with gluten is a major cause of inadvertent non-adherence, while the limited availability, high costs, and poor quality of certified gluten-free products are responsible for intentionally breaking a GFD. Therefore, several studies in the last decade have indicated that many patients with CD who follow a GFD still have difficulty controlling their diet and, therefore, regularly consume enough gluten to trigger symptoms and damage the small intestine.

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Detection and quantification of gluten immunogenic peptides in feces of infants and their relationship with diet

Cited by 9 publications

References 22 publications

Determination of gluten immunogenic peptides for the management of the treatment adherence of celiac disease: A systematic review

Determination of gluten immunogenic peptides for the management of the treatment adherence of celiac disease: A systematic review

Testing for fecal gluten immunogenic peptides: a useful tool to evaluate compliance with gluten-free diet by celiacs

Challenges of Monitoring the Gluten-Free Diet Adherence in the Management and Follow-Up of Patients with Celiac Disease

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