@misc{10481/71658,
year = {2021},
month = {9},
url = {http://hdl.handle.net/10481/71658},
abstract = {BACKGROUND
Gluten is a complex mixture of proteins with immunogenic peptide sequences
triggering the autoimmune activity in patients with celiac disease (CeD). Gluten
immunogenic peptides (GIP) are resistant to gastrointestinal digestion and are
then excreted via the stool and urine. Most common detection methods applied in
the follow-up visits for CeD patients such as serology tests, dietetic interviews,
questionnaires, and duodenal biopsy have been proved to be inefficient, invasive,
or inaccurate for evaluating gluten-free diet (GFD) compliance. Determination of
excreted GIP in stool and urine has been developed as a non-invasive, direct, and
specific test for GFD monitoring.
AIM
To summarize published literature about the clinical utility of GIP determination
in comparison to the tools employed for GFD monitoring.
METHODS
PubMed and Web of Science searches were performed using the keywords
“gluten immunogenic peptides” or “gluten immunogenic peptide” and a combination of the previous terms with “feces”, “stools”, “urine”, “celiac
disease”, “gluten-free diet”, and “adherence” to identify relevant clinical studies
published in English and Spanish between 2012 to January 2021. Reference lists
from the articles were reviewed to identify additional pertinent articles. Published
articles and abstracts reporting the clinical use of GIP determination in stool
and/or urine for the follow-up of patients with CeD in comparison with other
tools in use were included. Case reports, commentaries, reviews, conference
papers, letters, and publications that did not focus on the aims of this review were
excluded.
RESULTS
Total of 15 publications were found that involved the use of GIP determination in
stool and/or urine to monitor the adherence to the GFD in comparison to other
tools. Studies included both children and adults diagnosed with CeD and healthy
volunteers. Overall, these preliminary studies indicated that this novel technique
was highly sensitive for the detection of GFD transgressions and therefore could
facilitate the follow-up of patients with CeD. Tools identified in this work
included the CeD-specific serology, dietetic questionnaires, symptomatology, and
the duodenal biopsy. Review of the literature revealed that the rates of GFD
adherence may vary between 30%-93% using either stool or urine GIP determination,
49%-96% by the serology, 59%-94% using the dietetic questionnaires, 56%-
95% by the reported symptoms and 44%-76% with the duodenal biopsy. In
addition, the association between the different methods and histological
abnormalities (Marsh II-III) was found to be 33%-100% for GIP determination
(stool and urine), 25%-39% for CeD-specific serology, 3%-50% for dietetic
questionnaires, and 22%-28% for the symptomatology.
CONCLUSION
Excreted GIP detection is the precise approach for determining voluntary or
involuntary gluten consumption in CeD patients preventing future complications
arising from gluten exposure.},
organization = {Instituto de Salud Carlos III
Spanish Government
European Commission	DI-16-08943	
DI-17-09627},
publisher = {Baishideng},
keywords = {Celiac disease},
keywords = {Gluten-free diet},
keywords = {Gluten immunogenic peptides},
keywords = {Immunoassays},
keywords = {Stool},
keywords = {Urine},
title = {Determination of gluten immunogenic peptides for the management of the treatment adherence of celiac disease: A systematic review},
doi = {10.3748/wjg.v27.i37.6306},
author = {Coto, Laura},
}