Nutrients · 10 authors, 4 centres
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This prospective study of 280 celiac disease patients found that 11.4% had positive urinary gluten immunogenic peptides (uGIP) despite reporting adherence to a gluten-free diet, and uGIP positivity correlated with duodenal atrophy. A key limitation is that a single urine sample may under-evaluate gluten exposure, and not all patients underwent histology or capsule endoscopy.
Celiac disease requires strict gluten-free diet (GFD) adherence, but monitoring is challenging due to limitations of serology, questionnaires, and invasive biopsies. Urinary gluten immunogenic peptides (uGIP) offer a direct method to detect gluten ingestion. Methods: This prospective cross-sectional study enrolled 280 celiac disease patients from April 2019 to February 2020 at a tertiary center. Patients were unaware of the uGIP test. Assessments included uGIP, celiac dietary adherence test (CDAT), visual analog scales (VAS), tissue transglutaminase antibodies (tTGA), duodenal histology, and video capsule endoscopy (VCE). Key Results: 32 patients (11.4%) had positive uGIP. uGIP positivity did not correlate with demographics, CDAT, VAS, or tTGA. However, uGIP+ patients had significantly higher rates of duodenal atrophy (66.7% vs 32.7%, p=0.01). VCE showed atrophy in 47.5% of patients, but no significant dependence on uGIP results. Limitations: A single urine sample may miss gluten exposure, and not all patients had equal evaluations (e.g., only 113 had histology, 61 had VCE). Implications: uGIP correlates with duodenal atrophy and may be a useful tool for monitoring GFD adherence, but further studies with multiple samples are needed to confirm its efficacy.
