A new study published online in The American Journal of Gastroenterology used fecal gluten immunogenic peptide (GIP) measurement to assess for patient compliance with the gluten-free diet. Gluten immunogenic peptides are pieces of gluten proteins that don’t get digested and produce immunotoxic reactions in patients with celiac disease. Traditionally, methods used to assess compliance ranged from unreliable (self-reporting questionnaires) to prohibitively expensive and invasive (small bowel biopsy).

The study included 188 celiac disease patients and 84 controls; ages ranged from 1 to 72 years. All celiac disease patients had been on the gluten-free diet for at least one year. All participants completed a dietary questionnaire and underwent fecal GIP testing. Participants were instructed to collect 2–4 g of stool sample in a sealed container after recording their food intake for four days. Once collected, the concentration of GIP in stools was measured.

Overall, about 18% of celiac disease patients were found to have gluten traces in their stool.  Compliance was found to be highest in the youngest patients, with children up to age three having the lowest rate of gluten traces found. Noncompliance increased with each subsequent age group, and men were significantly more likely to show gluten traces than were women. Evidence of gluten consumption was detected in all but one of the control participants.

The study concludes, not surprisingly, that adherence to the gluten-free diet is difficult, and that patients are commonly ingesting gluten, be it intentionally or unintentionally. The good news is that this test can be used to objectively measure compliance, and is a good addition to the celiac disease management toolkit due to its non-invasive nature. “Tests to monitor gluten consumption are finally available to researchers in the United States,” stated Francisco Leon, MD, Chief Medical Officer of Celimmune, “and we hope they will soon be available to U.S. consumers too.” The hope is that this test will help Americans with celiac disease and non-celiac wheat sensitivity comply with the gluten-free diet.

Patients with celiac disease who do not adhere to a strict, gluten-free diet have been found to have an increased mortality risk, and report poorer quality of life. They often have significant nutritional deficiencies and are at an increased risk for associated autoimmune disorders, other serious conditions, and cancers. Long-term follow-up care is needed to assure patient compliance and positive health outcomes.

View our Adult Celiac Disease Follow-Up Checklist.

View our Pediatric Celiac Disease Follow-Up Checklist.

To read the full study, click here.

Assessing for Compliance with the Gluten-Free Diet