Seetharaman Keerthivasan, Lal Sadhna Bhasin, Prasad Kaushal Kishor, Kumar Yashwant, Bhatia Alka, Malhotra Sunita
Division of Pediatric Gastroenterology and Hepatology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Dig Dis Sci. 2023 Feb;68(2):529-540. doi: 10.1007/s10620-022-07762-8. Epub 2022 Dec 2.
A strict lifelong gluten-free diet (GFD) remains the only treatment of celiac disease (CD). Adherence to gluten-free diet is best reflected by mucosal healing. Noninvasive tools capable of predicting mucosal recovery in CD patients need to be identified.
To compare the ability of various modalities used to assess compliance to GFD, for predicting persistent mucosal damage in children with CD.
A prospective, single-center, observational study on children with CD on a GFD was conducted between January 2020 and April 2021. Children with CD on GFD were consecutively enrolled and various modalities used to assess adherence to GFD were compared.
One hundred and fifty children (Mean age 12.2 ± 3.6 years, 58% Boys) on GFD (Mean duration 6 ± 3.1 years) were enrolled in the study. Persistent mucosal damage was seen in 88% of the enrolled. Fecal gluten immunogenic peptide (GIP) was positive in 87.8% (129/147). Antibodies to tissue transglutaminase (TGA-IgA) and/or deamidated gliadin peptide (DGP) were positive in 32% (48/150) whereas antibody to synthetic neoepitopes of TGA-IgA was positive in 24.8% (37/149). Non-compliance as assessed by local questionnaire, Biagi score, and dietitian detailed interview were 62.7%, 60%, and 75.3%, respectively. Serology had the highest specificity (83%) and fecal GIP had the highest sensitivity (89%). On logistic regression analysis, only non-compliance by Biagi score predicted poor mucosal recovery.
Fecal GIP may be sensitive to detect only "one-point dietary transgression." None of the existing modalities used to assess compliance to GFD accurately predict persistent mucosal damage. A subset of patients may develop gluten tolerance.
严格的终身无麸质饮食（GFD）仍然是乳糜泻（CD）的唯一治疗方法。无麸质饮食的依从性最好通过黏膜愈合来体现。需要确定能够预测CD患者黏膜恢复情况的非侵入性工具。
比较用于评估GFD依从性的各种方法预测CD儿童持续性黏膜损伤的能力。
2020年1月至2021年4月对接受GFD治疗的CD儿童进行了一项前瞻性、单中心观察性研究。连续纳入接受GFD治疗的CD儿童，并比较用于评估GFD依从性的各种方法。
150名接受GFD治疗（平均持续时间6±3.1年）的儿童（平均年龄12.2±3.6岁，58%为男孩）被纳入研究。88%的入组儿童存在持续性黏膜损伤。粪便麸质免疫原性肽（GIP）阳性率为87.8%（129/147）。抗组织转谷氨酰胺酶抗体（TGA-IgA）和/或去酰胺化麦醇溶蛋白肽（DGP）阳性率为32%（48/150），而抗TGA-IgA合成新表位抗体阳性率为24.8%（37/149）。通过当地问卷、比亚吉评分和营养师详细访谈评估的不依从率分别为62.7%、60%和75.3%。血清学特异性最高（83%），粪便GIP敏感性最高（89%）。逻辑回归分析显示，只有比亚吉评分评估的不依从性可预测黏膜恢复不良。
粪便GIP可能仅对“单点饮食违规”敏感。用于评估GFD依从性的现有方法均无法准确预测持续性黏膜损伤。一部分患者可能会产生麸质耐受性。
