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Minerva Gastroenterologica e Dietologica 2020 Mar 24

DOI: 10.23736/S1121-421X.20.02662-8

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Fecal gluten immunogenic peptides as indicators of dietary compliance in celiac patients

Brunetta PORCELLI 1 , Fabio FERRETTI 2, Francesca CINCI 1, Ivano BIVIANO 3, Alessia SANTINI 3, Elisabetta GRANDE 4, Francesco QUAGLIARELLA 4, Lucia TERZUOLI 1, Maria Romana BACARELLI 2, Nicola BIZZARO 5, Marina VASCOTTO 4, Mario MARINI 3

1 Sezione di Biochimica, Dipartimento Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy; 2 Dipartimento Scienze Mediche, Chirurgiche e Neuroscienze, Università degli Studi di Siena, Siena, Italy; 3 UOC Gastroenterologia ed Endoscopia Operativa, Azienda Ospedaliera Universitaria Senese, Siena, Italy; 4 UOC Pediatria, Azienda Ospedaliera Universitaria Senese, Siena, Italy; 5 Laboratorio di Patologia Clinica, Ospedale San Antonio, Azienda Sanitaria Universitaria Integrata di Udine, Tolmezzo, Udine, Italy


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BACKGROUND: It is important to have methods for evaluating dietary compliance in patients with celiac disease (CD). Determination of fecal gluten immunogenic peptides (GIPs) was recently proposed as a method of detecting gluten intake. The aim of this study was to evaluate whether determination of GIPs can be used as an indicator of compliance with a gluten-free diet (GFD).
METHODS: Twenty-five persons with CD on a gluten-free diet for at least one year were enrolled in the study. Compliance with the diet was assessed by: the Biagi questionnaire, evaluation of symptoms and assay of IgA anti-tissue transglutaminase antibodies (IgA anti-tTG). GIPs were determined by iVYLISA GIP-S test (Biomedal S.L., Seville, Spain) on an automated Chorus analyzer (DIESSE Diagnostica Senese, Siena, Italia), after extraction of fecal samples by the method developed by DIESSE.
RESULTS: Four patients tested positive for GIPs (GIP+), two of whom complied strictly with the gluten- free diet according to the Biagi questionnaire. None of the four GIP-positive patients manifested symptoms. IgA anti-tTG was significantly higher in GIP+ than in GIP- subjects.
CONCLUSIONS: Assay of fecal GIPs identified more patients who were not complying with the diet than the Biagi questionnaire or evaluation of symptoms. The anti-tTG and GIP results agreed perfectly; however, since anti-tTG antibodies remain high for longer and are not a completely reliable marker of GFD intake, detection of fecal GIPs offers a direct, objective, quantitative assessment of exposure, even occasional, to gluten and could be used to check dietary compliance.


KEY WORDS: Fecal gluten immunogenic peptides; Gluten free diet; Celiac disease

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