Small Bowel Section, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina.
Hospital Universitario INGESA, Ceuta, Spain.
Am J Clin Nutr. 2023 Dec;118(6):1106-1112. doi: 10.1016/j.ajcnut.2023.10.001. Epub 2023 Oct 6.
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.
在乳糜泻（CeD）中，坚持无麸质饮食（GFD）对于控制症状和黏膜愈合至关重要，但评估其依从性具有一定难度。
我们旨在比较连续 4 周的粪便麸质免疫原性肽（GIP）测量与常用于监测 GFD 依从性的常规工具。
连续邀请布宜诺斯艾利斯胃肠病医院小肠科就诊的成年 CeD 患者参加这项观察性研究，并指导他们在连续 4 周的每个星期五收集粪便样本。每周平均粪便 GIP 浓度进行估计。将 GIP 结果与依从性自评量表、特定的 CeD 血清学、乳糜泻症状指数和营养师的评估进行比较。
共纳入 53 例 CeD 患者，其中粪便 GIP≥0.65μg/g/周（n=13；24.5%）的患者血清中脱酰胺麦胶蛋白肽（DGPs）抗体浓度更高[69（29-109）比 14（13-29）；P=0.0005]和 IgA 组织转谷氨酰胺酶[42（14-200）比 10（7-16）；P=0.02]，IgA DGP 抗体>20AU/mL 的病例比例更高[84.6%比 33.3%；P=0.002]，自我评估的依从性评分更高[5（4-9）比 9（7-10）；P=0.003]。GIP 与乳糜泻症状指数评分无相关性（55.6%比 30.8%；P=0.9）。营养师评估发现，当粪便 GIP 较高时，69%（优势比[OR]：5.25；95%CI：1.1-27.2；P=0.01）的患者存在不依从情况。Logistic 回归分析确定 IgA DGP（调整 OR：1.1；95%CI：1.01-1.11；P=0.02）和男性（调整 OR：28.3；95%CI：1.1-722.6；P=0.04）与过度摄入麸质独立相关。
每周粪便 GIP 可检测到不常被常用 GFD 依从性评估方法检测到的麸质暴露。粪便 GIP 浓度越高，血清学和营养师访谈的预测价值越好。粪便 GIP 是一种用于 GFD 监测的有用且实用的检测方法，尤其适用于实际场景中的风险性麸质暴露。
