Stool gluten peptide detection is superior to urinary analysis, coeliac serology, dietary adherence scores and symptoms in the detection of intermittent gluten exposure in coeliac disease: a randomised, placebo-controlled, low-dose gluten challenge study

Russell, Amy K.Immunology Division, The Walter and Eliza Hall Institute, Parkville, VIC 3052, Australia (author)

Stool gluten peptide detection is superior to urinary analysis, coeliac serology, dietary adherence scores and symptoms in the detection of intermittent gluten exposure in coeliac disease : a randomised, placebo-controlled, low-dose gluten challenge study

Monitoring adherence to a gluten-free diet is an important goal of coeliac disease management. Urine and stool gluten immunogenic peptide (GIP) assays provide an objective readout of gluten ingestion, with the former favoured due to its convenience and acceptability. This study assessed stool GIP excretion after low-dose gluten challenge designed to mimic accidental gluten exposure. A total of 52 coeliac participants undertook a randomised, double-blind gluten (50–1000 mg) or placebo challenge. Stool and urinary GIP, serology, dietary adherence and symptoms were assessed. Stool GIP was 100% sensitive for gluten intake ≥250 mg and 71% for 50 mg. Peak GIP detection was 12–36 h after gluten exposure. The mean stool GIP after 1000 mg gluten ingestion remained above the limit of quantification for 5 days. Urine GIP assessment had poor sensitivity for GIP excretion compared to stool. Serology, dietary adherence score and symptoms did not correlate with gluten excretion during lead-in. We conclude that stool GIP detection is highly sensitive, with levels related to gluten dose and time from ingestion. Weekly or bi-weekly testing will detect low-level exposure more effectively than urine GIP assessments or traditional methods. In this seronegative, apparently well-treated cohort, a high frequency of baseline-positive GIP suggests ongoing gluten exposure, but the assessment of patient behaviour and assay specificity is needed.

Lucas, Erin C.Immunology Division, The Walter and Eliza Hall Institute, Parkville, VIC 3052, Australia (author)
Henneken, Lee M.Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia (author)
Pizzey, Catherine J.Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia (author)
Clarke, DeanNational Measurement Institute, Port Melbourne, VIC 3207, Australia (author)
Myléus, Anna,MD PhDUmeå universitet,Allmänmedicin(Swepub:umu)anamys98 (author)
Tye-Din, Jason A.Immunology Division, The Walter and Eliza Hall Institute, Parkville, VIC 3052, Australia;Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia;Department of Medical Biology, University of Melbourne, Parkville, VIC 3052, Australia;The Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia (author)
Immunology Division, The Walter and Eliza Hall Institute, Parkville, VIC 3052, AustraliaDepartment of Gastroenterology, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia (creator_code:org_t)

By the author/editor: Russell, Amy K.; Lucas, Erin C.; Henneken, Lee M.; Pizzey, Catherin ...; Clarke, Dean; Myléus, Anna, MD ...; show more...; Tye-Din, Jason A ...; show less...

About the subject

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Gastroenterology ...

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