In Gluten-Sensitive Patients, Novel Test Suggests Symptoms May Have Other Causes
PHILADELPHIA—Gluten immunogenic peptide (GIP) measurements—a novel method of monitoring gluten-free diet (GFD) adherence—may also help determine whether or not gluten ingestion is the sole cause of symptoms in patients with non-celiac gluten sensitivity (NCGS).
The study, which received the Fellows-in-Training Award in the Small Intestine Category at the American College of Gastroenterology (ACG) 2018 Annual Scientific Meeting, aimed to investigate the GIP method in patients with NCGS. It had not been assessed previously in this patient population.
YOU MIGHT LIKE
Is Celiac Disease Prevalent Among Type 2 Diabetes Patients?
Gluten-Free Diet Has No Effect on Depression, Insomnia in CD Patients
In their single-center prospective, randomized, double-blinded, cross-over trial, Apeksha Shah, MD, from Thomas Jefferson University Hospital in Philadelphia, PA, and colleagues aimed to evaluate the efficacy of GIP measurements in 39 healthy controls and 26 patients with NCGS—defined as symptoms induced by gluten ingestion despite the absence of celiac disease or wheat allergy.
At baseline, all participants were educated about GFDs at the Jefferson Celiac Center and were placed on a strict GFD for the entirety of the study. Following a 7-day run-in period with placebo, participants received 0.5 g to 2.0 g gluten daily for 7 days. For the remainder of the 4-week study, they received placebo.
The Celiac Symptom Index (CSI) was used to assess NCGS symptoms. In addition, because GIPs are resistant to digestion and are detectable in stool and urine when gluten is consumed, samples of each were collected weekly to determine GFD compliance.
“Importantly and conversely, GIP is not detected in patients on a gluten-free diet,” explained Dr Shah in her presentation at ACG 2018 on October 9.
At the end of the study, stool and urine samples indicated that the NCGS group was indeed more adherent to the GFD compared with healthy controls (odds ratio [OR] 0.251 and 0.230, respectively).
Participants in both groups were more likely to have GIP in their stool samples when receiving gluten (OR 4.815). However, the results of the study demonstrated no differences in symptom severity upon receipt of placebo or gluten in patients with NCGS (32.69 vs 31.54) or healthy controls (23.87 vs 23.59).
Perhaps most notably, although patients with NCGS were found to have significantly higher CSI scores at baseline (32.69 vs 23.87) and while receiving gluten (31.54 vs 23.59) vs healthy controls, no worsening of symptoms following gluten ingestion was observed in either group based on CSI scores.
“[W]e concluded that NCGS patients may have some component other than gluten that is provoking their symptoms,” said Dr Shah.
—Christina Vogt
Reference:
Shah A, Moleski S, Matthews M, et al. Symptoms of gluten ingestion in patients with non-celiac gluten sensitivity: a placebo-controlled study. Paper presented at: American College of Gastroenterology 2018 Annual Scientific Meeting; October 9, 2018; Philadelphia, PA.