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Gluten immunogenic peptides in faeces and urine

RC 2017 2


Dr Alfonso Rodriguez-Herrera is a medical specialist in paediatrics with special interest in paediatric gastroenterology and nutrition. He gained his PhD from the University of Seville with a thesis on coeliac disease. Currently he is head of gastroenterology of IHP, a large medical company based in southern Spain. He is an associate professor at Pablo Olavide University.  He recently co-authored papers with the Faculty of Pharmacy, Seville on 'Monitoring of gluten free diet compliance in celiac patients by assessment of gliadin 33-mer equivalent epitopes in feces' and 'Detection of gluten immunogenic peptides in the urine of patients with coeliac disease reveals transgressions in the gluten free diet and incomplete mucosal healing'. He has been granted with several awards in the area of paediatric gastroenterology.


There is a general consensus that strict adherence to a gluten free diet (GFD) in coeliac patients leads to full clinical and histological remission. It is linked to an improvement in quality of life and reduced long term complications. Persistent gluten exposure is usually unintentional. Exposure may occur no matter how careful a patient is, due to cross contamination or simple lack of knowledge regarding the diet. Blood antibody testing (mostly tTGA) is used in CD management however, the evidence suggests that it is not sensitive enough to detect occasional significant dietary transgressions that impede mucosal healing. 

The resistance of gluten peptides to gastrointestinal digestion, in particular gluten immunogenic peptides (GIP) related to the immunotoxic 33-mer peptide, ensures that an important part of the ingested gluten is eliminated in faeces. A proportional fraction of the GIP absorbed in the gastrointestinal tract makes it to the circulation and is excreted in urine. Detection of GIP in faeces and urine has been proposed as a new non invasive biomarker to detect gluten intake and verify GFD compliance in patients with CD. 

In a clinical setting the response rate to a GFD was evaluated by dietary questionnaire, coeliac serology, and correlations between faecal GIP and traditional methods of monitoring the GFD have been investigated. The majority of children with CD, between zero and three years of age showed faeces negative for GIP, revealing good compliance. The proportion of patients with faeces positive for GIP increased in children between four and 12 years of age. No association was detected between faecal GIP and dietary questionnaire or anti-tTG antibodies. GIP analysis in samples of faeces and urine could resolve some scientific and clinical problems in CD management such as detection of inadvertent lapses after appearance of acute symptoms; non compliance assessment of the GFD before onset of any anatomic damage; to prove gluten intake during CD diagnosis; examining the adherence to the GFD in the initial period after diagnosis when patients are less familiar with this diet.

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