Gluten immunogenic peptide excretion detects dietary transgressions in treated celiac disease patients

Costa, Ana F.; Sugai, Emilia; Temprano, María de la Paz; Niveloni, Sonia I.; Vázquez, Horacio; Moreno, María Laura; Domínguez-Flores, M Remedios; Muñoz-Suano, Alba; Smecuol, Edgardo; Stefanolo, Juan P.; Gonzalez, Andrea F.; Cebolla-Ramirez, Angel; Mauriño, Eduardo; Verdú, Elena F.; Bai, Julio C.

doi:10.3748/wjg.v25.i11.1409

Cited by 72 publications

(67 citation statements)

References 28 publications

(48 reference statements)

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“…Our findings suggest that symptoms associated with IBS are incorrectly attributed to recent exposure to gluten, even though IBS is common in patients treated for coeliac disease. 21 Our findings also highlight the limitations of symptoms in general as a clear-cut readout of gluten ingestion and, for clinicians, underscore the value of employing sensitive objective measures of gluten exposure, such as gluten immunogenic peptide assays of urine 23 or faeces, 24,25 to correlate symptoms with true episodes of gluten exposure.…”

Section: Discussionmentioning

confidence: 76%

Masked bolus gluten challenge low in FODMAPs implicates nausea and vomiting as key symptoms associated with immune activation in treated coeliac disease

Daveson

Tye–Din

Goel³

et al. 2019

Aliment Pharmacol Ther

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Summary Background In patients with coeliac disease, FODMAPs in gluten‐containing foods, and participant anticipation of a harmful (‘nocebo’) effect, may contribute to acute symptoms after gluten challenge. Aim To establish acute gluten‐specific symptoms linked to immune activation in coeliac disease Methods We included 36 coeliac disease patients on a gluten‐free diet receiving placebo in the RESET CeD trial. Double‐blind, bolus vital wheat gluten (~6‐g gluten protein) and sham challenges low in FODMAPs were consumed 2 weeks apart. Assessments included daily Coeliac Disease Patient Reported Outcome (CeD PRO) symptom scores (0‐10), adverse events and serum interleukin‐2 (baseline and 4 hours). Results Median CeD PRO score for nausea increased most (sham: 0 vs gluten: 5.5; P < .001). Apart from tiredness (1 vs 4, P = .005) and headache (0 vs 2, P = .002), changes in other symptoms were small or absent. Only nausea increased significantly in occurrence with gluten (11% vs 69%, P < .001). Without nausea, only tiredness and flatulence were common after gluten. Nausea (6% vs 61%, P < .001; median onset: 1:34 hours) and vomiting (0% vs 44%, P < .001; 1:51 hours) were the only adverse events more common with gluten than sham. Interleukin‐2 was always below the level of quantitation (0.5 pg/mL) at baseline, and after sham. Interleukin‐2 was elevated after gluten in 97% of patients (median fold‐change: 20), and correlated with severity of nausea (rs = .49, P = .0025) and occurrence of vomiting (P = .0005). Conclusions Nausea and vomiting are relatively specific indicators of acute gluten ingestion, and correlate with immune activation. IBS‐like symptoms without nausea are unlikely to indicate recent gluten exposure.

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Section: Discussionmentioning

confidence: 76%

Masked bolus gluten challenge low in FODMAPs implicates nausea and vomiting as key symptoms associated with immune activation in treated coeliac disease

Daveson

Tye–Din

Goel³

et al. 2019

Aliment Pharmacol Ther

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“…The use of faecal and urine gluten immunogenic peptides (GIPs) may provide a practical non-invasive future approach to monitor for gluten exposure in individuals. In a recent study, patients with CD who reported adherence to a strict GFD had a positive GIP, despite the majority of these individuals being asymptomatic [37]. This highlights the potential utility of using GIPs in assessing ongoing gluten exposure.…”

Section: Dietary Indiscretionmentioning

confidence: 99%

Non-Responsive Coeliac Disease: A Comprehensive Review from the NHS England National Centre for Refractory Coeliac Disease

et al. 2020

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Coeliac disease is a common small intestinal enteropathy which manifests following ingestion of gluten in genetically susceptible individuals. Since gluten was identified as the driving factor in coeliac disease, the gluten-free diet (GFD) has remained the mainstay of treatment. While most individuals will display improvement in symptoms and signs of coeliac disease following institution of the GFD, up to 30% will continue to experience symptoms and/or have persisting intestinal inflammation. These individuals can be classified as having non-responsive coeliac disease (NRCD), which may be associated with dietary indiscretion, slow healing, refractory coeliac disease, and/or an alternative condition. The purpose of this review is to provide an overview of the causes of NRCD in adults, highlight a systematic approach to investigate these patients, and appraise the latest management aspects of this subset of coeliac disease.

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“…Although still modest in size, this is the largest published study on the influence of a GFD instituted shortly after T1D onset. To our knowledge, we are the only researchers to assess adherence to GFD intervention using laboratory stool tests for gluten antigens . We also administered QoL questionnaires at the end of the intervention to assess whether a GFD is associated with an additional psychological burden.…”

Section: Discussionmentioning

confidence: 99%

Gluten‐free diet in children with recent‐onset type 1 diabetes: A 12‐month intervention trial

Neuman

Průhová

Kulich

et al. 2020

Diabetes Obesity Metabolism

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Aim: To test whether a gluten-free diet (GFD) is associated with the deceleration of the decline in beta-cell capacity in non-coeliac children with recently diagnosed type 1 diabetes.Methods: Forty-five children (aged 10.2 ± 3.3 years) were recruited into a selfselected intervention trial: 26 started with a GFD within a median of 38 days postonset, whereas 19 remained on a standard diet. The main outcomes were the decline in C-peptide area under the curve (AUC) in mixed-meal tolerance tests (MMTTs) at 6 and 12 months relative to 1 month after diabetes onset and the difference in insulin dose, insulin dose-adjusted A1c (IDAA1c) and HbA1c assessed every 3 months. The adherence to the GFD was verified by immunoreactive gluten in the stool and by food questionnaires at every visit. Quality of life (QoL) questionnaires were administered to the participants at the end of the intervention at 12 months.The data were analysed as per protocol (in 39 subjects who duly completed the whole follow-up: 20 in the GFD group, 19 in the control group) by linear and longitudinal regression models adjusted for sex, age and baseline variables.Results: At 12 months, the difference in C-peptide AUC between subjects in the GFD group and controls was 205 pmol/L (95% CI -223 to 633; P = 0.34) in a model adjusted for age, sex and body weight, and for baseline insulin dose, MMTT C-peptide AUC and HbA1c assessed at 1 month after diagnosis. In a longitudinal analysis of all three time points adjusted for age, sex and body weight, C-peptide declined more slowly in the GFD group than in controls, with the difference in trends being 409 pmol/L/year (P = 0.04). The GFD group had a marginally lower insulin dose (by 0.15 U/kg/day; P = 0.07), a lower IDAA1c (by 1.37; P = 0.01) and a lower mean HbA1c (by 0.7% [7.8 mmol/mol]; P = 0.02) than those of the controls at 12 months. There was no appreciable difference between the groups in daily carbohydrate intake (P = 0.49) or in the QoL reported by the patients (P = 0.70) and their parents/caregivers (P = 0.59). Conclusions:A GFD maintained over the first year after type 1 diabetes diagnosis was associated with better HbA1c and a prolonged partial remission period. There was a hint of slower C-peptide decline but the association was not strong enough to make definite conclusions.

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Gluten immunogenic peptide excretion detects dietary transgressions in treated celiac disease patients

Cited by 72 publications

References 28 publications

Masked bolus gluten challenge low in FODMAPs implicates nausea and vomiting as key symptoms associated with immune activation in treated coeliac disease

Masked bolus gluten challenge low in FODMAPs implicates nausea and vomiting as key symptoms associated with immune activation in treated coeliac disease

Non-Responsive Coeliac Disease: A Comprehensive Review from the NHS England National Centre for Refractory Coeliac Disease

Gluten‐free diet in children with recent‐onset type 1 diabetes: A 12‐month intervention trial

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