Patients with celiac regularly exposed to gluten, even on a gluten-free diet

Testing for gluten immunogenic peptides in fecal and urine sample from patients with celiac disease revealed that these patients were frequently exposed to gluten, according to study results.

“Based on evidence established by recent studies, the gluten immunogenic peptide [GIP] tests have emerged as specific tools that add value to the previous strategies used to identify gluten exposure,” Julio C. Bai, MD, of Dr. C. Bonorino Udaondo Gastroenterology Hospital in Argentina, and colleagues wrote. “We hypothesized that the use of GIP testing would provide information on patterns of exposure to gluten in celiac disease patients.”

Researchers conducted a prospective study comprising 53 patients with celiac disease who had adhered to a gluten-free diet for more than 2 years. Patients collected stool samples every Friday and Saturday, as well as urine samples every Sunday for 4 weeks. Investigators measured GIP using ELISA testing on the stool and point-of-care tests on the urine samples.

Bai and colleagues found that of 420 total samples, 159 were positive for GIP. Additionally, 88.7% of patients had at least one fecal or urine sample that tested positive for GIP.

The number of patients with a sample that tested positive for GIP increased over the course of the 4-week study period (urine sample in week 1 vs. week 4, P < .05), and patients with symptoms had more weeks in which GIP was detected in stool than patients without symptoms (P < .05).

Bai and colleagues wrote that inadvertent gluten exposure, particularly during weekends, might explain the persistence of symptoms despite adherence to a gluten-free diet.

“We believe that this study could help increase the understanding of frequency of gluten exposure in a real-life scenario and lead to the development of new strategies to improve long-term dietary monitoring,” they wrote. “More research is necessary to establish guidelines for the applicability of GIP testing to improve gluten-free diet compliance.” – by Alex Young

Disclosure: The authors report no relevant financial disclosures.