Diagnosis- research into a non-invasive tool

The process for diagnosis of coeliac disease involves a blood test that detects antibodies specific to coeliac disease followed by endoscopy with a biopsy. The National Institute for Health and Clinical excellence (NICE) guideline on the recognition of coeliac disease recommends the use of tissue transglutaminase or endomysial antibody blood tests to help to identify people with the condition as they have high sensitivity and specificity for coeliac disease.

A recent Dutch pilot study looked at a possible non-invasive tool for early diagnosis and follow up of coeliac disease once established on the gluten-free diet.

Non-invasive tool for diagnosis

The plasma/urinary markers, intestinal fatty acid binding protein (I-FABP) and liver fatty acid binding protein (L-FABP) are markers of damage to intestinal epithelial cells and could potentially be used for diagnosis.

Recent study

A recent study looked at samples of intestinal tissue from various parts of the gut from the stomach to the sigmoid colon. FABP was measured and quantified by Western blot analysis (a technique used to test specific proteins in a tissue) and enzyme linked immunosorbent assay (ELISA). Analysis was also taken on antibodies against I-FABP and L-FABP.

The results found that I-FABP and L-FABP was expressed specifically on mature enterocytes present on the tip of the villi in the small intestine, in particular the jejunum.

Further tests were then carried out to see if serum concentrations of FABP differed between people with and people without coeliac disease.

Serum FABP concentrations were measured by ELISA in 62 healthy volunteers. A further 13 people newly diagnosed with coeliac disease via biopsy had their serum FABP concentrations measured. The mean serum FABP level was found to be higher in people with coeliac disease compared to healthy controls and mean normal serum levels.

The final test was to check if FABP levels returned to normal after starting a gluten-free diet. I-FABP and L-FABP were measured in ten people within one year of starting the diet and levels were found to have decreased significantly. FABP concentrations could be measured to monitor the effect of the gluten-free diet on recovery of the intestinal mucosa of people with coeliac disease.

Further research

Further research is underway to assess the use of FABP in the management of people with coeliac disease by looking at the correlation between urinary FABP levels and the level of gut damage. The potential of urinary FABP concentrations as a tool for evaluating the effect of the gluten-free diet is also being researched in children to see if this can be used as a non-invasive tool in follow up.

Derikx, J. P. M. et al (2009) A pilot study on the non-invasive evaluation of intestinal damage in celiac disease using I-FABP and L-FABP. Journal of Clinical Gastroenterology 43, 727–733