Association in Clinical Practice Between Gluten Intake and Gluten Immunogenic Peptides in Celiac Children

Overview

Journal Gastro Hep Adv

Specialty Gastroenterology

Date 2024 Aug 12

PMID 39132079

Authors

Caroline R Meijer

Jaap Bakker

Anneloes Boers

Sophie Jansen

Zeliha Mengi

Maria Luisa Mearin

Affiliations

Soon will be listed here.

Abstract

Background And Aims: The dietary compliance and its assessment in celiac disease (CD) patients on a strict gluten-free diet (GFD) remain a challenge. Two relatively new, validated methods have been proposed to detect occasional gluten ingestion: standardized dietary questionnaire and determination of urinary gluten immunogenic peptides (GIPs). Our aim was to prospectively assess dietary compliance via these methods and compare their results with those of tissue transglutaminase antibodies (tTGA).

Methods: This was a prospective single-center study. Consecutive CD patients (aged 1-18 years) on a GFD scheduled for regular consultation between March and August 2019 were invited. In addition to standard care, a completed dietary questionnaire and urine sample for GIP were collected. Pearson's chi-square test, Fisher's exact test, and Mann-Whitney U test were performed.

Results: Of the 156 eligible children, 110 provided informed consent. Completed dietary questionnaire, GIP, and tTGA results were available from 86 children (median age 12.8 years, median GFD duration 30 months, 65% female). Adherence to the GFD evaluated by GIP, dietary questionnaire, and anti-tTGA was 94.2%, 75.6% and 94.2%, respectively. No association was found between the tTGA results and the detection of GIP, as well as between the tTGA results and the dietary questionnaires scores ( = .5 and .312, respectively). The participants perceived both the questionnaire and the measurement of GIP as reassuring with regard to correct implementation of the GFD.

Conclusion: All the 3 methods have limitations to monitor dietary compliance. The comparison of their performance shows that the best single method is the use of the validated dietary questionnaire, which should therefore be implemented in the regular care for children with CD. The most effective combination of dietary questionnaire and urinary GIP determination should be used in specific clinical situations.

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Low Levels of Detectable Urine and Stool GIPs in Children with Celiac Disease on a Gluten-Free Diet.

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References

Wessels M, Dolinsek J, Castillejo G, Donat E, Riznik P, Roca M . Follow-up practices for children and adolescents with celiac disease: results of an international survey. Eur J Pediatr. 2021; 181(3):1213-1220. DOI: 10.1007/s00431-021-04318-2. View

Porcelli B, Ferretti F, Biviano I, Santini A, Cinci F, Vascotto M . Testing for fecal gluten immunogenic peptides: a useful tool to evaluate compliance with gluten-free diet by celiacs. Ann Gastroenterol. 2020; 33(6):631-637. PMC: 7599348. DOI: 10.20524/aog.2020.0530. View

Silvester J, Comino I, Rigaux L, Segura V, Green K, Cebolla A . Exposure sources, amounts and time course of gluten ingestion and excretion in patients with coeliac disease on a gluten-free diet. Aliment Pharmacol Ther. 2020; 52(9):1469-1479. PMC: 7780203. DOI: 10.1111/apt.16075. View

Ruiz-Carnicer A, Garzon-Benavides M, Fombuena B, Segura V, Garcia-Fernandez F, Sobrino-Rodriguez S . Negative predictive value of the repeated absence of gluten immunogenic peptides in the urine of treated celiac patients in predicting mucosal healing: new proposals for follow-up in celiac disease. Am J Clin Nutr. 2020; 112(5):1240-1251. DOI: 10.1093/ajcn/nqaa188. View

White L, Bannerman E, Gillett P . Coeliac disease and the gluten-free diet: a review of the burdens; factors associated with adherence and impact on health-related quality of life, with specific focus on adolescence. J Hum Nutr Diet. 2016; 29(5):593-606. DOI: 10.1111/jhn.12375. View

Vahedi K, Mascart F, Mary J, Laberenne J, Bouhnik Y, Morin M . Reliability of antitransglutaminase antibodies as predictors of gluten-free diet compliance in adult celiac disease. Am J Gastroenterol. 2003; 98(5):1079-87. DOI: 10.1111/j.1572-0241.2003.07284.x. View

Husby S, Koletzko S, Korponay-Szabo I, Mearin M, Phillips A, Shamir R . European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr. 2011; 54(1):136-60. DOI: 10.1097/MPG.0b013e31821a23d0. View

Migliarese Isaac D, Rajani S, Yaskina M, Huynh H, Turner J . Antitissue Transglutaminase Normalization Postdiagnosis in Children With Celiac Disease. J Pediatr Gastroenterol Nutr. 2016; 65(2):195-199. DOI: 10.1097/MPG.0000000000001480. View

Sansotta N, Alessio M, Norsa L, Previtali G, Ferrari A, Guerra G . Trend of Antitissue Transglutaminase Antibody Normalization in Children With Celiac Disease Started on Gluten-free Diet: A Comparative Study Between Chemiluminescence and ELISA Serum Assays. J Pediatr Gastroenterol Nutr. 2019; 70(1):37-41. DOI: 10.1097/MPG.0000000000002519. View

10.

Comino I, Segura V, Ortigosa L, Espin B, Castillejo G, Garrote J . Prospective longitudinal study: use of faecal gluten immunogenic peptides to monitor children diagnosed with coeliac disease during transition to a gluten-free diet. Aliment Pharmacol Ther. 2019; 49(12):1484-1492. PMC: 6767519. DOI: 10.1111/apt.15277. View

11.

Itzlinger A, Branchi F, Elli L, Schumann M . Gluten-Free Diet in Celiac Disease-Forever and for All?. Nutrients. 2018; 10(11). PMC: 6267495. DOI: 10.3390/nu10111796. View

12.

Costa A, Sugai E, Temprano M, Niveloni S, Vazquez H, Moreno M . Gluten immunogenic peptide excretion detects dietary transgressions in treated celiac disease patients. World J Gastroenterol. 2019; 25(11):1409-1420. PMC: 6429344. DOI: 10.3748/wjg.v25.i11.1409. View

13.

Myleus A, Reilly N, Green P . Rate, Risk Factors, and Outcomes of Nonadherence in Pediatric Patients With Celiac Disease: A Systematic Review. Clin Gastroenterol Hepatol. 2019; 18(3):562-573. DOI: 10.1016/j.cgh.2019.05.046. View

14.

Werkstetter K, Korponay-Szabo I, Popp A, Villanacci V, Salemme M, Heilig G . Accuracy in Diagnosis of Celiac Disease Without Biopsies in Clinical Practice. Gastroenterology. 2017; 153(4):924-935. DOI: 10.1053/j.gastro.2017.06.002. View

15.

Stefanolo J, Talamo M, Dodds S, Temprano M, Costa A, Moreno M . Real-World Gluten Exposure in Patients With Celiac Disease on Gluten-Free Diets, Determined From Gliadin Immunogenic Peptides in Urine and Fecal Samples. Clin Gastroenterol Hepatol. 2020; 19(3):484-491.e1. DOI: 10.1016/j.cgh.2020.03.038. View

16.

Wessels M, Te Lintelo M, Vriezinga S, Putter H, Hopman E, Mearin M . Assessment of dietary compliance in celiac children using a standardized dietary interview. Clin Nutr. 2017; 37(3):1000-1004. DOI: 10.1016/j.clnu.2017.04.010. View

17.

Comino I, Fernandez-Banares F, Esteve M, Ortigosa L, Castillejo G, Fambuena B . Fecal Gluten Peptides Reveal Limitations of Serological Tests and Food Questionnaires for Monitoring Gluten-Free Diet in Celiac Disease Patients. Am J Gastroenterol. 2016; 111(10):1456-1465. PMC: 5059698. DOI: 10.1038/ajg.2016.439. View

18.

Hogen Esch C, Wolters V, Gerritsen S, Putter H, von Blomberg B, van Hoogstraten I . Specific celiac disease antibodies in children on a gluten-free diet. Pediatrics. 2011; 128(3):547-52. DOI: 10.1542/peds.2010-3762. View

19.

Moreno M, Cebolla A, Munoz-Suano A, Carrillo-Carrion C, Comino I, Pizarro A . Detection of gluten immunogenic peptides in the urine of patients with coeliac disease reveals transgressions in the gluten-free diet and incomplete mucosal healing. Gut. 2015; 66(2):250-257. PMC: 5284479. DOI: 10.1136/gutjnl-2015-310148. View

20.

Moreno M, Rodriguez-Herrera A, Sousa C, Comino I . Biomarkers to Monitor Gluten-Free Diet Compliance in Celiac Patients. Nutrients. 2017; 9(1). PMC: 5295090. DOI: 10.3390/nu9010046. View