Negative predictive value of the repeated absence of gluten immunogenic peptides in the urine of treated celiac patients in predicting mucosal healing: new proposals for follow-up in celiac disease.

Autor:	Ruiz-Carnicer Á; Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, Seville, Spain., Garzón-Benavides M; Digestive Disease Clinical Unit, Gastroenterology Division, Virgen del Rocío Hospital, Seville, Spain., Fombuena B; Digestive Disease Clinical Unit, Gastroenterology Division, Virgen del Rocío Hospital, Seville, Spain., Segura V; Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, Seville, Spain., García-Fernández F; Digestive Disease Clinical Unit, Gastroenterology Division, Virgen del Rocío Hospital, Seville, Spain., Sobrino-Rodríguez S; Digestive Disease Clinical Unit, Gastroenterology Division, Virgen del Rocío Hospital, Seville, Spain., Gómez-Izquierdo L; Pathology Service, Virgen del Rocío Hospital, Seville, Spain., Montes-Cano MA; Institute of Biomedicine of Seville (IBiS), Seville, Spain; Faculty of Medicine, University of Seville, Seville, Spain., Rodríguez-Herrera A; Saint Luke's General Hospital, Kilkenny, Ireland., Millán R; Digestive Disease Clinical Unit, Gastroenterology Division, Virgen del Rocío Hospital, Seville, Spain., Rico MC; Digestive Disease Clinical Unit, Gastroenterology Division, Virgen del Rocío Hospital, Seville, Spain., González-Naranjo C; Digestive Disease Clinical Unit, Gastroenterology Division, Virgen del Rocío Hospital, Seville, Spain., Bozada-García JM; Endoscopy of Digestive Diseases Clinical Unit, Virgen del Rocío Hospital, Seville, Spain., Díaz J; Clinical Analysis Service, Hospital Universitario INGESA, Ceuta, Spain., Coronel-Rodríguez C; Health Center Amante Laffón, Seville, Spain., Espín B; Pediatric, Gastroenterology, Hepatology and Nutrition Section, Virgen del Rocio Children's Hospital, Seville, Spain., Romero-Gómez M; Digestive Disease Clinical Unit, Gastroenterology Division, Virgen del Rocío Hospital, Seville, Spain., Cebolla Á; Biomedal SL, Seville, Spain., Sousa C; Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, Seville, Spain., Comino I; Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, Seville, Spain., Argüelles F; Digestive Diseases Clinical Unit, Virgen Macarena Hospital, Seville, Spain., Pizarro Á; Digestive Disease Clinical Unit, Gastroenterology Division, Virgen del Rocío Hospital, Seville, Spain.
Jazyk:	angličtina
Zdroj:	The American journal of clinical nutrition [Am J Clin Nutr] 2020 Nov 11; Vol. 112 (5), pp. 1240-1251.
DOI:	10.1093/ajcn/nqaa188
Abstrakt:	Background: The treatment of celiac disease (CD) is a lifelong gluten-free diet (GFD). The current methods for monitoring GFD conformance, such as a dietary questionnaire or serology tests, may be inaccurate in detecting dietary transgressions, and duodenal biopsies are invasive, expensive, and not a routine monitoring technique. Objectives: Our aim was to determine the clinical usefulness of urine gluten immunogenic peptides (GIP) as a biomarker monitoring GFD adherence in celiac patients and to evaluate the concordance of the results with the degree of mucosal damage. Methods: A prospective observational study was conducted involving 22 de novo CD patients, 77 celiac patients consuming a GFD, and 13 nonceliac subjects. On 3 d of the week, urine samples were collected and the GIP concentrations were tested. Simultaneously, anti-tissue transglutaminase antibodies, questionnaire results, clinical manifestations, and histological findings were analyzed. Results: Approximately 24% (18 of 76) of the celiac patients consuming a GFD exhibited Marsh II-III mucosal damage. Among this population, 94% (17 of 18) had detectable urine GIP; however, between 60% and 80% were asymptomatic and exhibited negative serology and appropriate GFD adherence based on the questionnaire. In contrast, 97% (31 of 32) of the celiac patients without duodenal damage had no detectable GIP. These results demonstrated the high sensitivity (94%) and negative predictive value (97%) of GIP measurements in relation to duodenal biopsy findings. In the de novo CD-diagnosed cohort, 82% (18 of 22) of patients had measurable amounts of GIP in the urine. Conclusions: Determining GIP concentrations in several urine samples may be an especially convenient approach to assess recent gluten exposure in celiac patients and appears to accurately predict the absence of histological lesions. The introduction of GIP testing as an assessment technique for GFD adherence may help in ascertaining dietary compliance and to target the most suitable intervention during follow-up. (Copyright © The Author(s) on behalf of the American Society for Nutrition 2020.)
Databáze:	MEDLINE
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