Monitoring the gluten free diet in children with celiac disease: Evaluation of fecal gliadin 33-mer equivalent in feces

Abstract

s / Digestive and Liver Disease 46 (2014) e71–e84 e75 MONITORING THE GLUTEN FREE DIET IN CHILDREN WITH CELIAC DISEASE: EVALUATION OF FECAL GLIADIN 33-MER EQUIVALENT IN FECES Tiziana Galeazzi1, Simona Gatti 1,∗, Alice Guazzarotti 1, Sara Quattrini2, Veronica Albano1, Carlo Catassi1 1 Dipartimento di Clinica Pediatrica, Universita Politecnica delle Marche, Ancona, Italy 2 Scienze dell’Alimentazione, Universita degli Studi di Firenze, Firenze, Italy Objective: Methods of evaluating gluten free diet (GFD) compliance include clinical, serological and histological tests, but currently a sensitive, specific and non-invasive method is lacking. Detection of gliadin immunopeptides in faeces has recently been described as a good method for short-term assessment of gluten intake. We aimed to investigate clinical usefulness of this test in a group of CD children. Methods: CD children on at least 6-months-GFD and healthy children on normal diet were enrolled. 3-day food diary was used to monitor the diet before the enrollment and adherence to “anticontamination rules” was evaluated by a 16 points questionnaire. Gastrointestinal symptomswere evaluated through theGSRS scale. iVYLISA GIP test (Biomedal, Sevilla) was used to analyze stool samples, collected after 3 days of food-record. Correlation between symptoms, food diary and questionnaire analysis were found. Results: 63 CD children (mean age: 10.63 years, SD: 4.78 years) and 17 controls (mean age: 7.97 years, SD: 4.66 years) were enrolled.MeanGFDdurationwas 3.66 years, SD: 2.73 years. Overall 36.51% of CD children have detectable amount of gluten in stools compared to 100% of controls. Mean GIP values in CD group were significantly lower compared to controls (p<0.0001). Conclusions: First results identify a high percentage of CD children with detectable traces of gluten in faeces. This may indicate incomplete GFD compliance; however, food diary and questionnaire results need tobe correlated. iVYLISAGIP test doesnot require sophisticate instruments and is a non-invasive test, resulting a promisingmethod to assessGFDcompliance, especially in children. http://dx.doi.org/10.1016/j.dld.2014.07.029 INFANT FEEDING PATTERN, HLA STATUS, AND PREVALENCE OF CELIAC DISEASE Elena Lionetti 1,∗, Stefania Castellaneta2, Ruggiero Francavilla3, Alfredo Pulvirenti4, Elio Tonutti 5, Sergio Amarri6, Maria Barbato7, Cristiana Barbera8, Graziano Barera9, Antonella Bellantoni10, Emanuela Castellano11, Maria Giovanna Limongelli 12, Salvatore Pellegrino13, Carlo Polloni14, Claudio Ughi15, Giovanna Zuin16, Graziella Guariso17, Alessio Fasano18, Carlo Catassi19 1 Department of Pediatrics, University of Catania, Catania, Italy 2 Department of Pediatrics, San Paolo Hospital, Bari, Italy 3 Department of Developmental Biomedicine, University of Bari, Bari, Italy 4 Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy 5 Department of Immunology and Allergology, Udine Hospital, Udine, Italy 6 Department of Pediatrics, AO-IRCCS Santa Maria Nuova Hospital, Reggio Emilia, Italy 7 Department of Pediatrics, La Sapienza University, Roma, Italy 8 Department of Pediatrics, University of Torino, Torino, Italy 9 Department of Pediatrics, San Raffaele Hospital, Milano, Italy 10 Department of Pediatrics, Bianchi-Melacrino Morelli Hospital, Reggio Calabria, Italy 11 Department of Pediatrics, Gaslini Institute, Genova, Italy 12 Department of Pediatrics, Federico II University of Naples, Napoli, Italy 13 Cystic Fibrosis and Pediatric Gastroenterology Unit, University Hospital “G. Martino”, Messina, Italy 14 Department of Pediatrics, Rovereto Hospital, Rovereto, Italy 15 Department of Pediatrics, University of Pisa, Pisa, Italy 16 Department of Pediatrics, Buzzi Children Hospital, Milano, Italy 17 Department of Pediatrics, University of Padova, Padova, Italy 18 Division of Pediatric Gastroenterology and Nutrition and Center for Celiac Research, Harvard Medical School, Boston, USA 19 Department of Pediatrics, Universita Politecnica delle Marche, Ancona, Italy Objective: The relationship between age at gluten introduction, early dietary pattern and risk of celiac disease (CD) is unclear. The primary aim of the studywas to evaluate in a large cohort of infants at increased risk for CD the role of age at gluten introduction on the risk of CD-autoimmunity (CDA) and of overt CD. Methods: Newborns with a CD-affected first-degree relative were randomly assigned to be introduced to gluten at 6 months (group A) or at 12 months (group B). HLA genotype was determined at 15 months, and CD serology was evaluated at 15, 24, 36, and 60months, and at 8 and 10 years. Intestinal biopsies were performed in cases with positive serology. The primary outcome was the prevalence of CDA and overt CD by trial arm at five years of age. Results: The proportion of children developing CDA and overt CD was significantly higher in group A than in group B at 2 years