Abstract：
Adherence to the gluten-free diet (GFD) is critical to achieving symptom control and mucosal healing in celiac disease (CeD), but its assessment is difficult.
We sought to compare stool gluten immunogenic peptides (GIPs) measurements over a 4-wk period with conventional tools commonly used to monitor compliance with a GFD.
Consecutive adult patients with CeD attending the Small Bowel Section of the Buenos Aires Gastroenterology Hospital were invited to this observational study and were instructed to collect stool samples on Fridays for 4 consecutive weeks. Weekly mean stool GIP concentration was measured was estimated. GIP results were compared with a self-assessment scale of adherence, specific CeD serology, the celiac symptom index, and the assessment by an expert dietitian.
Fifty-three CeD patients were enrolled and those with stool GIP ≥0.65 μg/g/wk (n = 13; 24.5%) had higher serum concentrations of IgA deamidated gliadin peptides (DGPs) antibodies [69 (29-109) compared with 14 (13-29); P = 0.0005] and IgA tissue transglutaminase [42 (14-200) compared with 10 (7-16); P = 0.02], higher proportion of cases with IgA DGP antibodies >20 AU/mL (84.6% compared with 33.3%; P = 0.002), and a higher self-estimated adherence score [5 (4-9) compared with 9 (7-10); P = 0.003]. GIP did not correlate with celiac symptom index scores (55.6% compared with 30.8%; P = 0.9). Expert dietitian assessment identified 69% [odds ratio (OR): 5.25; 95% CI: 1.1-27.2; P = 0.01] of nonadherent cases when high stool GIP. Logistic regression analysis determined that IgA DGP (adjusted OR: 1.1; 95% CI: 1.01-1.11; P = 0.02) and males (adjusted OR: 28.3; 95% CI: 1.1-722.6; P = 0.04) were independently associated with excessive gluten exposure.
Weekly stool GIP identifies gluten exposure that is not always detected by commonly used GFD adherence assessment methods. The higher the concentration of stool GIP, the better the predictive value of serology and dietitian interviews. Stool GIP is a useful and practical test for GFD monitoring, particularly for risky gluten exposure in real-life scenarios.
We sought to compare stool gluten immunogenic peptides (GIPs) measurements over a 4-wk period with conventional tools commonly used to monitor compliance with a GFD.
Consecutive adult patients with CeD attending the Small Bowel Section of the Buenos Aires Gastroenterology Hospital were invited to this observational study and were instructed to collect stool samples on Fridays for 4 consecutive weeks. Weekly mean stool GIP concentration was measured was estimated. GIP results were compared with a self-assessment scale of adherence, specific CeD serology, the celiac symptom index, and the assessment by an expert dietitian.
Fifty-three CeD patients were enrolled and those with stool GIP ≥0.65 μg/g/wk (n = 13; 24.5%) had higher serum concentrations of IgA deamidated gliadin peptides (DGPs) antibodies [69 (29-109) compared with 14 (13-29); P = 0.0005] and IgA tissue transglutaminase [42 (14-200) compared with 10 (7-16); P = 0.02], higher proportion of cases with IgA DGP antibodies >20 AU/mL (84.6% compared with 33.3%; P = 0.002), and a higher self-estimated adherence score [5 (4-9) compared with 9 (7-10); P = 0.003]. GIP did not correlate with celiac symptom index scores (55.6% compared with 30.8%; P = 0.9). Expert dietitian assessment identified 69% [odds ratio (OR): 5.25; 95% CI: 1.1-27.2; P = 0.01] of nonadherent cases when high stool GIP. Logistic regression analysis determined that IgA DGP (adjusted OR: 1.1; 95% CI: 1.01-1.11; P = 0.02) and males (adjusted OR: 28.3; 95% CI: 1.1-722.6; P = 0.04) were independently associated with excessive gluten exposure.
Weekly stool GIP identifies gluten exposure that is not always detected by commonly used GFD adherence assessment methods. The higher the concentration of stool GIP, the better the predictive value of serology and dietitian interviews. Stool GIP is a useful and practical test for GFD monitoring, particularly for risky gluten exposure in real-life scenarios.
摘要：
目的：坚持无麸质饮食（GFD）对于乳糜泻（CeD）的症状控制和粘膜愈合至关重要，但是它的评估是困难的。我们试图将4周内的粪便麸质免疫原性肽（GIP）测量值与常用于监测无麸质饮食（GFD）依从性的常规工具进行比较。
方法：连续成年CeD患者，参加布宜诺斯艾利斯胃肠病医院的小肠科，被邀请参加这项观察研究，并被指示在星期五连续四周收集粪便样本。估计每周平均粪便GIP浓度。将GIP结果与依从性自我评估量表进行比较，特异性CeD血清学，腹腔症状指数(CSI)，以及专家营养师的评估。
结果：纳入53例CeD患者，粪便GIP≥0.65μg/g/周（n=13；24.5％）的血清IgA脱酰胺化麦醇溶蛋白肽（DGP）抗体浓度较高（69[29-109]vs.14[13-29]；p=0.0005）和IgA组织转谷氨酰胺酶（tTG）（42[14-200]vs.10[7-16]；p=0.02)，IgADGP抗体>20AU/mL的病例比例更高(84.6%vs.33.3%；p=0.002)，和更高的自我估计依从性得分（5[4-9]与9[7-10]；p=0.003）。GIP与CSI得分无关（55.6％与30.8%；p=0.9）。专家营养师评估确定了69%(OR:5.25,[95%CI:1.1-27.2];p=0.01)的非粘附性高便GIP病例。Logistic回归分析确定IgADGP（aOR：1.1[95％CI：1.01-1.11]；p=0.02）和男性（aOR：28.3[95％CI：1.1-722.6]；p=0.04）与过度谷蛋白暴露独立相关。
结论：每周粪便GIP可识别常用GFD依从性评估方法并不总是检测到的麸质暴露。大便GIP水平越高，血清学和营养师访谈的预测价值越好。粪便GIP是GFD监测的有用和实用的测试，特别是现实生活中的危险麸质暴露。
方法：连续成年CeD患者，参加布宜诺斯艾利斯胃肠病医院的小肠科，被邀请参加这项观察研究，并被指示在星期五连续四周收集粪便样本。估计每周平均粪便GIP浓度。将GIP结果与依从性自我评估量表进行比较，特异性CeD血清学，腹腔症状指数(CSI)，以及专家营养师的评估。
结果：纳入53例CeD患者，粪便GIP≥0.65μg/g/周（n=13；24.5％）的血清IgA脱酰胺化麦醇溶蛋白肽（DGP）抗体浓度较高（69[29-109]vs.14[13-29]；p=0.0005）和IgA组织转谷氨酰胺酶（tTG）（42[14-200]vs.10[7-16]；p=0.02)，IgADGP抗体>20AU/mL的病例比例更高(84.6%vs.33.3%；p=0.002)，和更高的自我估计依从性得分（5[4-9]与9[7-10]；p=0.003）。GIP与CSI得分无关（55.6％与30.8%；p=0.9）。专家营养师评估确定了69%(OR:5.25,[95%CI:1.1-27.2];p=0.01)的非粘附性高便GIP病例。Logistic回归分析确定IgADGP（aOR：1.1[95％CI：1.01-1.11]；p=0.02）和男性（aOR：28.3[95％CI：1.1-722.6]；p=0.04）与过度谷蛋白暴露独立相关。
结论：每周粪便GIP可识别常用GFD依从性评估方法并不总是检测到的麸质暴露。大便GIP水平越高，血清学和营养师访谈的预测价值越好。粪便GIP是GFD监测的有用和实用的测试，特别是现实生活中的危险麸质暴露。
