Gluten Immunogenic Peptides (GIP) Point-of-Care Urine Test in Coeliac Disease Follow-up before and during the COVID-19 Lockdown in Italy

Ciacci, Carolina; Gagliardi, Mario; Siniscalchi, Mario; Ruotolo, Monica; Santonicola, Antonella; Hajji, Najla; Zingone, Fabiana

doi:10.2147/ceg.s326137

Cited by 7 publications

(4 citation statements)

References 13 publications

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“…Furthermore, coeliac serology lacks sensitivity in the follow-up of CD [12,13], and mucosal healing can take years to achieve [4,5], meaning it is difficult to differentiate ongoing gluten exposure from slow healing, from RCD1 in some patients. Several recent studies have documented the utility of measuring urine and/or faecal GIPs as a marker of dietary gluten adherence in uncomplicated CD [14][15][16][29][30][31][32]. These studies have reported a window of detection for urine tests ranging from 4 h to 48 h after gluten ingestion [14,29], and a sensitivity of 95% following gluten doses of 2 g or more [33].…”

Section: Discussionmentioning

confidence: 99%

Non-Responsive and Refractory Coeliac Disease: Experience from the NHS England National Centre

et al. 2022

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We characterised the aetiology of non-responsive coeliac disease (NRCD) and provided contemporary mortality data in refractory coeliac disease (RCD) from our centre. We also measured urine gluten immunogenic peptides (GIPs) in patients with established RCD1 to evaluate gluten exposure in these individuals. Methods: This was a longitudinal cohort study conducted in Sheffield, UK. Between 1998 and 2019, we evaluated 285 adult (≥16 years) patients with NRCD or RCD. Patients with established RCD1 and persisting mucosal inflammation and/or ongoing symptoms provided three urine samples for GIP analysis. Results: The most common cause of NRCD across the cohort was gluten exposure (72/285; 25.3%). RCD accounted for 65/285 patients (22.8%), 54/65 patients (83.1%) had RCD1 and 11/65 patients (16.9%) had RCD2. The estimated 5-year survival was 90% for RCD1 and 58% for RCD2 (p = 0.016). A total of 36/54 (66.7%) patients with RCD1 underwent urinary GIP testing and 17/36 (47.2%) had at least one positive urinary GIP test. Conclusion: The contemporary mortality data in RCD2 remains poor; patients with suspected RCD2 should be referred to a recognised national centre for consideration of novel therapies. The high frequency of urinary GIP positivity suggests that gluten exposure may be common in RCD1; further studies with matched controls are warranted to assess this further.

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Section: Discussionmentioning

confidence: 99%

Non-Responsive and Refractory Coeliac Disease: Experience from the NHS England National Centre

et al. 2022

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“…The presence of gluten immunogenic peptides (GIPs) in the urine and stool may make it possible to monitor compliance and identify individuals who were not following a GFD. These tests might be useful for telemedicine-assisted CD monitoring [ 54 , 106 , 107 ].…”

Section: Resultsmentioning

confidence: 99%

Utilizing Telemedicine Applications in Celiac Disease and Other Gluten-Free-Diet-Dependent Conditions: Insights from the COVID-19 Pandemic

Haimi,

Lerner

2024

Healthcare

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Background: Globally, approximately 1.4% of people have celiac disease (CD), induced by gluten sensitivity. If left untreated, it causes small intestinal inflammation and villous atrophy, which can result in failure to thrive, anemia, osteoporosis, malabsorption, and even malignancy. The only treatment option available is a gluten-free diet (GFD). Few studies have looked at the role and perception of telehealth in relation to CD and selective nutrition both before and after the COVID-19 pandemic. Aim: Our goal was to screen and investigate the research conducted both before and after the COVID-19 pandemic concerning the utilization of telehealth applications and solutions in CD and other GFD-dependent circumstances. Methods: We employed a narrative review approach to explore articles that were published in scholarly journals or organizations between the years 2000 and 2024. Only English-language publications were included. PubMed and Google Scholar searches were mainly conducted using the following keywords: telemedicine, telehealth, telecare, eHealth, m-health, COVID-19, SARS-CoV-2, celiac disease, and gluten-free diet (GFD). Manual searches of the references in the acquired literature were also carried out, along with the authors’ own personal contributions of their knowledge and proficiency in this field. Results: Only a few studies conducted prior to the COVID-19 outbreak examined the viewpoints and experiences of adult patients with CD with relation to in-person clinic visits, as well as other options such as telehealth. The majority of patients believed that phone consultations were appropriate and beneficial. Video conferencing and telemedicine became more popular during the COVID-19 pandemic, demonstrating the effectiveness of using these technologies for CD on a global basis. In recent years, urine assays for gluten identification have become accessible for use at home. These tests could be helpful for CD monitoring with telemedicine assistance. Conclusions: The extended knowledge gathered from the COVID-19 pandemic is expected to complement pre-COVID-19 data supporting the usefulness of telemedicine even after the emergent pandemic, encouraging its wider adoption in standard clinical practice. The monitoring and follow-up of CD patients and other GFD-dependent conditions can greatly benefit from telemedicine.

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“…Studies have suggested that by urinary GIPs, gluten ingestion as low as 25-50 mg can be identified and that positive results are indicative of gluten ingestion over the previous several hours to days [55]. Therefore, testing urinary and faecal GIPs may provide information on adherence to the GFD and dietary transgressions [56]. However, there is debate over the reliability of its use to assess adherence to a GFD [57,58].…”

Section: Gluten Immunogenic Peptidesmentioning

confidence: 99%

Monitoring coeliac disease in 2024, time to change practice?

Raju,

Shiha,

Penny

2024

Current Opinion in Gastroenterology

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Purpose of review Persistent villous atrophy is associated with morbidity in coeliac disease and most commonly due to ongoing gluten ingestion. Current methods for assessing gluten exposure and persisting villous atrophy include dietary questionnaires and repeat duodenal biopsy, which have limited accuracy or are invasive. This review discusses adjunctive and/or novel tests that could be used to overcome these challenges. Recent findings Small bowel capsule endoscopy is well tolerated and helps to evaluate for persisting villous atrophy and importantly, complications associated with coeliac disease. Testing for urinary and/or stool gluten immunogenic peptides may help identify recent gluten exposure, but further studies are still warranted to evaluate the accuracy and applicability of this approach. Measuring spikes in circulating Interleukin-2 following gluten challenge has shown promise for coeliac disease diagnosis, and thus may serve as a useful confirmatory test in those with persisting symptoms but provides no information on mucosal inflammation. No specific gut microbial signature has been identified in coeliac disease; however, studies have shown a reduced microbial diversity in active disease, which with future refinement may prove clinically useful. Summary There is no evidence to support alternative methods for assessing persisting villous atrophy in coeliac disease over performing an up-to-date duodenal biopsy. Monitoring for adherence to a gluten-free diet remains clinically challenging and should be a priority for future research.

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Gluten Immunogenic Peptides (GIP) Point-of-Care Urine Test in Coeliac Disease Follow-up before and during the COVID-19 Lockdown in Italy

Cited by 7 publications

References 13 publications

Non-Responsive and Refractory Coeliac Disease: Experience from the NHS England National Centre

Non-Responsive and Refractory Coeliac Disease: Experience from the NHS England National Centre

Utilizing Telemedicine Applications in Celiac Disease and Other Gluten-Free-Diet-Dependent Conditions: Insights from the COVID-19 Pandemic

Monitoring coeliac disease in 2024, time to change practice?

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