Abstract
A lifelong gluten-free diet (GFD) is the only current treatment for celiac disease (CD), but strict compliance is complicated. Duodenal biopsies are the “gold standard” method for diagnosing CD, but they are not generally recommended for disease monitoring. We evaluated the sensitivity and specificity of fecal gluten immunogenic peptides (GIPs) to detect duodenal lesions in CD patients on a GFD and compared them with serum anti-tissue transglutaminase (tTG) IgA antibodies. A prospective study was conducted at two tertiary centers in Spain on a consecutive series of adolescents and adults with CD who maintained a long-lasting GFD. Adherence to a GFD and health-related quality of life were scored with validated questionnaires. Mucosal damage graded according to the Marsh–Oberhüber classification (Marsh 1/2/3) was used as the reference standard. Of the 97 patients included, 27 presented duodenal mucosal damage and 70 had normal biopsies (Marsh 0). The sensitivity (33%) and specificity (81%) of GIPs were similar to those provided by the two assays used to measure anti-tTG antibodies. Scores in questionnaires showed no association with GIP, but an association between GIPs and patients’ self-reported gluten consumption was found (p = 0.003). GIP displayed low sensitivity but acceptable specificity for the detection of mucosal damage in CD.
Highlights
Celiac disease (CD) is a chronic immune-mediated enteropathy, triggered and maintained by gluten consumption in genetically predisposed individuals, and characterized by damage of variable intensity in their duodenal mucosa [1]
Mean age was close to 40 years old, and patients were on a gluten-free diet (GFD) for a mean of 105 months, that is, almost 9 years
Monitoring strict compliance of a GFD is controversial in celiac disease (CD) management [27]
Summary
Celiac disease (CD) is a chronic immune-mediated enteropathy, triggered and maintained by gluten consumption in genetically predisposed individuals, and characterized by damage of variable intensity in their duodenal mucosa [1]. A lifelong adherence to a gluten-free diet (GFD) is currently the only therapy for these patients, which usually leads to complete mucosal recovery. Continuous gluten exposure causes permanent damage in the duodenal mucosa of celiac patients and increases the risk of bone and endocrinological diseases [6] or intestinal lymphoma [7]; lack of adherence to a GFD reduces health-related quality of life (HRQoL) [8]. Monitoring sustained adherence to a GFD in celiac patients is, essential. This is mainly undertaken by surveying symptoms, administering nutritional questionnaires, and using non-invasive serological markers. Persistence of duodenal mucosal lesions is more commonly found in adults compared to children and in those with a shorter time on a GFD [10,11]
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