Comino, IsabelFernández-Bañares, FernandoEsteve, MaríaOrtigosa, LuísCastillejo, GemmaFambuena, BlancaRibes-Koninckx, CarmenSierra, CarlosRodríguez-Herrera, AlfonsoSalazar, José CarlosCaunedo, ÁngelMarugán-Miguelsanz, J MGarrote, José AntonioVivas, SantiagoLo Iacono, OresteNuñez, AlejandroVaquero, LuisVegas, Ana MaríaCrespo, LauraFernández-Salazar, LuisArranz, EduardoJiménez-García, Victoria AlejandraAntonio Montes-Cano, MarcoEspín, BeatrizGalera, AnaValverde, JustoGirón, Francisco JoséBolonio, MiguelMillán, AntonioMartínez Cerezo, FrancescGuajardo, CésarAlberto, José RamónRosinach, MercéSegura, VerónicaLeón, FranciscoMarinich, JorgeMuñoz-Suano, AlbaRomero-Gómez, ManuelCebolla, ÁngelSousa, Carolina2017-06-292017-06-292016-10-11Comino I, Fernández-Bañares F, Esteve M, Ortigosa L, Castillejo G, Fambuena B, et al. Fecal Gluten Peptides Reveal Limitations of Serological Tests and Food Questionnaires for Monitoring Gluten-Free Diet in Celiac Disease Patients. Am. J. Gastroenterol.. 2016 ; 111(10):1456-14650002-9270http://hdl.handle.net/10668/2726JOURNAL ARTICLE;OBJECTIVES Treatment for celiac disease (CD) is a lifelong strict gluten-free diet (GFD). Patients should be followed-up with dietary interviews and serology as CD markers to ensure adherence to the diet. However, none of these methods offer an accurate measure of dietary compliance. Our aim was to evaluate the measurement of gluten immunogenic peptides (GIP) in stools as a marker of GFD adherence in CD patients and compare it with traditional methods of GFD monitoring. METHODS We performed a prospective, nonrandomized, multicenter study including 188 CD patients on GFD and 84 healthy controls. Subjects were given a dietary questionnaire and fecal GIP quantified by enzyme-linked immunosorbent assay (ELISA). Serological anti-tissue transglutaminase (anti-tTG) IgA and anti-deamidated gliadin peptide (anti-DGP) IgA antibodies were measured simultaneously. RESULTS Of the 188 celiac patients, 56 (29.8%) had detectable GIP levels in stools. There was significant association between age and GIP in stools that revealed increasing dietary transgressions with advancing age (39.2% in subjects ≥13 years old) and with gender in certain age groups (60% in men ≥13 years old). No association was found between fecal GIP and dietary questionnaire or anti-tTG antibodies. However, association was detected between GIP and anti-DGP antibodies, although 46 of the 53 GIP stool-positive patients were negative for anti-DGP. CONCLUSIONS Detection of gluten peptides in stools reveals limitations of traditional methods for monitoring GFD in celiac patients. The GIP ELISA enables direct and quantitative assessment of gluten exposure early after ingestion and could aid in the diagnosis and clinical management of nonresponsive CD and refractory CD. Trial registration number NCT02711397.enEnfermedad celíacaDieta sin glutenEnsayo de inmunoadsorción enzimáticaProteínas de unión al GTPGliadinaGlútenesHumanosInmunoglobulina AMasculinoCooperación del pacientePéptidosEstudios prospectivosEncuestas y cuestionariosTransglutaminasasMedical Subject Headings::Diseases::Nutritional and Metabolic Diseases::Metabolic Diseases::Malabsorption Syndromes::Celiac DiseaseMedical Subject Headings::Phenomena and Processes::Physiological Phenomena::Nutritional Physiological Phenomena::Diet::Diet, Gluten-FreeMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Immunologic Techniques::Immunohistochemistry::Immunoenzyme Techniques::Enzyme-Linked Immunosorbent AssayMedical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Carrier Proteins::GTP-Binding ProteinsMedical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Plant Proteins::Seed Storage Proteins::Prolamins::Glutens::GliadinMedical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Plant Proteins::Seed Storage Proteins::Prolamins::GlutensMedical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::HumansMedical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Blood Proteins::Immunoproteins::Immunoglobulins::Antibodies::Immunoglobulin Isotypes::Immunoglobulin AMedical Subject Headings::Check Tags::MaleMedical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Delivery of Health Care::Attitude to Health::Patient Acceptance of Health Care::Patient ComplianceMedical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::PeptidesMedical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Health Care Evaluation Mechanisms::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Prospective StudiesMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Surveys and QuestionnairesMedical Subject Headings::Chemicals and Drugs::Enzymes and Coenzymes::Enzymes::Transferases::Acyltransferases::Aminoacyltransferases::Transglutaminasesresearch article27644734open access10.1038/ajg.2016.4391572-0241PMC5059698