Comparison of Methods to Monitor Gluten Intake in Celiac Disease Patients

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A new study compared clinical methods (e.g., blood tests) with fecal gluten immunogenic peptide (GIP)—a direct measure of gluten intake—to determine the accuracy of monitoring gluten intake in children with celiac disease.

GIP is a small part of gluten that cannot be digested and is found in the stool and urine of healthy individuals, celiac disease patients, and those with non-celiac gluten/wheat intolerance. The results suggest that adding GIP measurements during follow-up appointments is likely to help doctors identify more cases in which patients are not adequately following the gluten-free diet.

Current clinical methods of monitoring how well patients follow the gluten-free diet continue to miss many cases of poor adherence. These methods include blood tests (e.g., serum tTG), self-report compliance questionnaires (i.e., the Biagi score), and interviewing patients about their diet history (i.e., clinical assessment).

While blood tests are very accurate for diagnosing celiac disease, they are not very good at identifying whether or not a patient is following a strict, gluten-free diet. Questionnaires and interviews depend on accurate knowledge of gluten-free foods and correctly remembering what was eaten over time.

In this study, researchers looked at 90 fecal samples from 63 children with celiac disease. Fecal GIP was measured using the iVYLISA GIP Stool ELISA kit. Patients with GIP below detectable levels were considered to be adequately following the gluten-free diet.

The results show that when using current clinical methods to monitor how well children are following the gluten-free diet, almost four out of five children who are not following the diet well enough will be missed. In addition, two out of 10 children who will be assessed as following the diet will not actually be adequately following the diet.

Fecal GIP (showing recent gluten intake) was found in 16% of patients with a previous diagnosis who were meant to be following a strict, gluten-free diet. Fecal GIP outperformed the other clinical methods evaluated in this study, with the second best method being serum tTG measurement, which failed to detect poor compliance in 50% of the patients.

Because fecal GIP becomes detectable about 3 days after gluten intake—or within 4-6 hours when using urine GIP—the test has been shown to be very useful for finding recent or repeated gluten consumption.

 

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