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

Isabel Comino, Verónica Segura, Luis Ortigosa, Beatríz Espín, Gemma Castillejo, José Antonio Garrote, Carlos Sierra, Antonio Millán, Carmen Ribes-Koninckx, Enriqueta Román, Alfonso Rodríguez-Herrera, Jacobo Díaz, Jocelyn Anne Silvester, Ángel Cebolla, Carolina Sousa, Isabel Comino, Verónica Segura, Luis Ortigosa, Beatríz Espín, Gemma Castillejo, José Antonio Garrote, Carlos Sierra, Antonio Millán, Carmen Ribes-Koninckx, Enriqueta Román, Alfonso Rodríguez-Herrera, Jacobo Díaz, Jocelyn Anne Silvester, Ángel Cebolla, Carolina Sousa

Abstract

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.

© 2019 The Authors. Alimentary Pharmacology & Therapeutics Published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Concentration of gluten immunogenic peptides (GIP) in stools of patients with newly diagnosed coeliac disease during monitoring of the gluten‐free diet. (A) Levels of faecal GIP at the basal and follow‐up visits (basal, 6, 12 and 24 mo). (B) Levels of faecal GIP at 6, 12 and 24 mo. (C) Levels of GIP in transgressing patients in the different follow‐up visits (log scale). GIP, gluten immunogenic peptides; LOQ, limit of quantification
Figure 2
Figure 2
Gluten immunogenic peptides detection on a GFD according to patient age. Percentage distribution of stools collected during a GFD with detectable GIP according to age. GIP, gluten immunogenic peptides. GFD, gluten‐free diet
Figure 3
Figure 3
Evolution of GIP, tTG and DGP antibodies in patients with newly diagnosed coeliac disease. (A) tTG and DGP antibody levels vs time. (B) Percentage of dietary transgressions according GIP, tTG and DGP antibodies during the study period. DGP, deamidated gliadin peptide antibody; tTG, tissue transglutaminase antibody; GFD, gluten‐free diet; GIP, gluten immunogenic peptides. The cut‐off >10 U/mL
Figure 4
Figure 4
Absolute reduction of tTG antibody level at (A) 6 mo and (B) 12 mo in patients with detectable GIP and non GIP detected. GIP, gluten immunogenic peptides; tTG, tissue transglutaminase

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