Analysis of gluten immunogenic peptides in feces to assess adherence to the gluten-free diet in pediatric celiac patient
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ORIGINAL CONTRIBUTION
Analysis of gluten immunogenic peptides in feces to assess adherence to the gluten‑free diet in pediatric celiac patients María Roca1 · Ester Donat1,2 · Etna Masip1,2 · Paula Crespo‑Escobar1,3 · Antonio José Cañada‑Martínez4 · Begoña Polo1,2 · Carmen Ribes‑Koninckx1,2 Received: 17 April 2020 / Accepted: 2 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose In celiac disease (CD) there is a need for precise and non-invasive tools to assess dietary compliance to the glutenfree diet (GFD). Our aim is to evaluate the efficacy of the detection of gluten immunogenic peptides (GIP) in feces, to monitor in real life, the adherence to GFD in pediatric patients with CD. Methods A cross-sectional, prospective study was conducted. Fecal samples from CD children were analyzed by a rapid immunochromatographic (IC) test and by an ELISA method, both based on the antigliadin 33-mer monoclonal antibody. Results Group 1 comprises 43 children on a GFD. According to the food records (FR), 39/43 patients were compliant with the GFD and gluten consumption was recorded in 4. GIP were detected in 15/43 individuals by the ELISA method and also in 7 by IC strips. Group 2: comprise 18 children at CD diagnosis; GIP levels decreased over time (p 6 months
DT detected in FR
Positive anti-TG2 in serum
Symptoms
11.6 ± 4.9 (1–17)
12 males
43/43
4/43
21/43
4/43
5.1 ± 3.2 (1–12)
9 males
0/18
0/18
18/18
16/18
CD celiac disease, GFD gluten-free diet, DT dietary transgressions, FR food record
13
European Journal of Nutrition
µg GIP/g feces (ELISA method)
40.0 20.0
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10.0 5.0 2.5 1.0
0.0
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IC Strips ● GIP no detected
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GIP detected
Fig. 2 Boxplot of IC strips results and concentration of GIP in feces by ELISA in group 1. Results of GIP analysis by ELISA are expressed in μg GIP/g feces and for IC strips as positive or negative
Subgroup 1a comprises 21 out of the 43 cases, all with positive IgA anti-TG2 (range 8 U/mL to > 128 U/mL); 4/21 referred occasional clinical symptoms (diarrhea, vomiting, and/or abdominal pain). In this subgroup, GIP were detected by ELISA in 10/21 cases (range 0.2–41.5; mean ± SD, 6.6 ± 12.8 µg GIP/g feces) and in 7 of the 10 also by IC strips; of them 2 were symptomatic. Three children (5, 11 and 15 years of age) admitted voluntary transgressions and in another one (7 years of age) involuntary transgressions were detected by the FR. In all of them GIP were detected in feces both by IC and by ELISA (range 2.3–41.5; mean ± SD, 12.2±19.5 µg GIP/g feces). Five out of the 6 children on a GFD for 6–12 months had anti-TG2 > 10× upper limit of normal (ULN) (age range 2–12 years; mean ± SD, 7.6 ± 3.8 years). GIP were detected by ELISA in 3 cases and in 2 of them also by IC strips. However the sixth child, on GFD for 8 months, had negative anti-TG2 and no GIP were detected by ELISA or IC. Subgroup 1b comprises 22 cases all IgA anti-TG2 negative and asymptomatic, both children and their paren
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