BACKGROUND & AIMS: It is not clear how often patients who are on gluten-free diets (GFDs) for treatment of celiac disease still are exposed to gluten. We studied levels of gluten immunogenic peptides (GIP) in fecal and urine samples, collected over 4 weeks, from patients with celiac disease on a long-term GFD. METHODS: We performed a prospective study of 53 adults with celiac disease who had been on a GFD for more than 2 years (median duration, 8 y; interquartile range, 5-12 y) in Argentina. At baseline, symptoms were assessed by the celiac symptom index questionnaire. Patients collected stool each Friday and Saturday and urine samples each Sunday for 4 weeks. We used a commercial enzyme-linked immunosorbent assay to measure GIP in stool and point-of-care tests to measure GIP in urine samples. RESULTS: Overall, 159 of 420 stool and urine samples (37.9%) were positive for GIP; 88.7% of patients had at least 1 fecal or urine sample that was positive for GIP (median, 3 excretions). On weekends (urine samples), 69.8% of patients excreted GIP at least once, compared with 62.3% during weekdays (stool). The number of patients with a sample that was positive for GIP increased over the 4-week study period (urine samples in week 1 vs week 4: P < .05). Patients with symptoms had more weeks in which GIP was detected in stool than patients without symptoms (P < .05). The number of samples that were positive for GIP correlated with titers of deamidated gliadin peptide IgA in patients' blood samples, but not with levels of tissue transglutaminase. CONCLUSIONS: Patients with celiac disease on a long-term GFD still frequently are exposed to gluten. Assays to detect GIP in stool and urine might be used to assist dietitians in assessment of GFD compliance.
BACKGROUND & AIMS: It is not clear how often patients who are on gluten-free diets (GFDs) for treatment of celiac disease still are exposed to gluten. We studied levels of gluten immunogenic peptides (GIP) in fecal and urine samples, collected over 4 weeks, from patients with celiac disease on a long-term GFD. METHODS: We performed a prospective study of 53 adults with celiac disease who had been on a GFD for more than 2 years (median duration, 8 y; interquartile range, 5-12 y) in Argentina. At baseline, symptoms were assessed by the celiac symptom index questionnaire. Patients collected stool each Friday and Saturday and urine samples each Sunday for 4 weeks. We used a commercial enzyme-linked immunosorbent assay to measure GIP in stool and point-of-care tests to measure GIP in urine samples. RESULTS: Overall, 159 of 420 stool and urine samples (37.9%) were positive for GIP; 88.7% of patients had at least 1 fecal or urine sample that was positive for GIP (median, 3 excretions). On weekends (urine samples), 69.8% of patients excreted GIP at least once, compared with 62.3% during weekdays (stool). The number of patients with a sample that was positive for GIP increased over the 4-week study period (urine samples in week 1 vs week 4: P < .05). Patients with symptoms had more weeks in which GIP was detected in stool than patients without symptoms (P < .05). The number of samples that were positive for GIP correlated with titers of deamidated gliadin peptide IgA in patients' blood samples, but not with levels of tissue transglutaminase. CONCLUSIONS:Patients with celiac disease on a long-term GFD still frequently are exposed to gluten. Assays to detect GIP in stool and urine might be used to assist dietitians in assessment of GFD compliance.
Authors: Govind K Makharia; Prashant Singh; Carlo Catassi; David S Sanders; Daniel Leffler; Raja Affendi Raja Ali; Julio C Bai Journal: Nat Rev Gastroenterol Hepatol Date: 2022-01-03 Impact factor: 46.802
Authors: Hugo A Penny; Anupam Rej; Elisabeth M R Baggus; Sarah H Coleman; Rosalie Ward; Graeme Wild; Gerd Bouma; Nick Trott; John A Snowden; Josh Wright; Simon S Cross; Marios Hadjivassiliou; David S Sanders Journal: Nutrients Date: 2022-07-05 Impact factor: 6.706
Authors: Jocelyn A Silvester; Isabel Comino; Lisa N Rigaux; Veronica Segura; Kathy H Green; Angel Cebolla; Dayna Weiten; Remedios Dominguez; Daniel A Leffler; Francisco Leon; Charles N Bernstein; Lesley A Graff; Ciaran P Kelly; Carolina Sousa; Donald R Duerksen Journal: Aliment Pharmacol Ther Date: 2020-09-27 Impact factor: 8.171
Authors: Sheeana Gangadoo; Piumie Rajapaksha Pathirannahalage; Samuel Cheeseman; Yen Thi Hoang Dang; Aaron Elbourne; Daniel Cozzolino; Kay Latham; Vi Khanh Truong; James Chapman Journal: Int J Mol Sci Date: 2021-02-17 Impact factor: 5.923
Authors: Gopal Veeraraghavan; Amelie Therrien; Maya Degroote; Allison McKeown; Paul D Mitchell; Jocelyn A Silvester; Daniel A Leffler; Alan M Leichtner; Ciaran P Kelly; Dascha C Weir Journal: World J Gastroenterol Date: 2021-04-07 Impact factor: 5.742
Authors: Aarón D Ramírez-Sánchez; Ineke L Tan; B C Gonera-de Jong; Marijn C Visschedijk; Iris Jonkers; Sebo Withoff Journal: Int J Mol Sci Date: 2020-11-12 Impact factor: 5.923