Prospective longitudinal study: use of faecal gluten immunogenic peptides to monitor children diagnosed with coeliac disease during transition to a gluten‐free diet

Abstract

Summary Background Treatment for coeliac disease is a lifelong strict gluten‐free diet. Although guidelines recommend regular follow‐up with dietary interviews and coeliac serology, these methods may be inaccurate. Aim To evaluate the usefulness of faecal gluten immunogenic peptides to support the diagnosis and to determine the adherence to the gluten‐free diet in coeliac children. Methods Multicentre prospective observational study including 64 coeliac children. Faecal gluten peptides, and tissue transglutaminase and deamidated gliadin peptide antibodies were analyzed at diagnosis, and 6, 12 and 24 months thereafter. Gluten consumption was estimated from gluten peptide levels. Results Most children (97%) had detectable gluten peptides at diagnosis. On a gluten‐free diet, the rate of gluten peptides increased from 13% at 6 months to 25% at 24 months. Mean estimated gluten exposure dropped from 5543 mg/d at diagnosis to 144 mg/d at 6 months, then increased to 606 mg/d by 24 months. In contrast, deamidated gliadin peptide antibodies normalised and only 20% had elevated tissue transglutaminase antibody by 24 months. The elevation of tissue transglutaminase antibody was more prolonged in patients with detectable gluten peptides (P < 0.05). Nevertheless, absolute levels of tissue transglutaminase antibody had low sensitivity to identify patients with detectable gluten peptides (P > 0.1). Dietitian assessment was only moderately correlated with gluten peptide detection (κ = 0.5). Conclusions Faecal gluten peptides testing may guide treatment of coeliac disease prior to diagnosis and during the assessment diet adherence. Further studies could determine if early identification of gluten exposure reduces the need for expensive/invasive investigations for non‐responsive coeliac disease. ClinicalTrials.gov Number: NCT02711397.

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

“…The subjects enrolled in the study had been on GFD for many years and, had they complied strictly, serum levels of anti-tTG IgA ought to have returned to normal. To the contrary, their anti-tTG IgA levels indicated repeated and not occasional gluten intake; this is consistent with a recent study by Comino et al [ 28 ] in which GIPs+ subjects showed serum concentrations of anti-tTG IgA >10 U/mL that persisted longer than in patients who tested negative to fecal GIPs.…”

Intestinal Permeability in Children with Celiac Disease after the Administration of Oligofructose-Enriched Inulin into a Gluten-Free Diet—Results of a Randomized, Placebo-Controlled, Pilot Trial

“…The detection of GIP in stool samples can inform about the adherence to the GFD [ 39 ]. In our study, before the intervention, in 2 participants (one person from placebo and one from Synergy 1 group), the GIP values exceeded the upper limit of quantification (5 µg GIP/g of feces), suggesting the intake of gluten prolamines.…”

Exposure sources, amounts and time course of gluten ingestion and excretion in patients with coeliac disease on a gluten‐free diet

“…These include immunomodulatory therapies as well as gluten-digesting enzymes that hydrolyse prolyl-peptide bonds that are resistant to human gastrointestinal luminal proteases. 8 Recently, tests for gluten in food, [9][10][11] and gluten immunogenic peptides (GIP) in stool 12,13 and urine 14 have been developed. These immunoassays rely upon the G12 and/or A1 antibodies, which bind GIP-gluten peptides resistant to intraluminal and serum proteases that are recognised by T cells of patients with coeliac disease.…”