Alimentary Tract
Dynamics of celiac disease-specific serology after initiation of a gluten-free diet and use in the assessment of compliance with treatment

https://doi.org/10.1016/j.dld.2009.07.011Get rights and content

Abstract

Background

The usefulness of celiac disease-related serology in monitoring patients on a gluten-free diet has been debated.

Aim

To describe serologic changes over time and assess whether serology tests can predict compliance with the gluten-free diet.

Methods

Sera obtained at baseline and every 3 months thereafter for 1 year in 82 adult celiac disease patients were assayed for: (1) IgA antigliadin, (2) IgA anti-tissue transglutaminase, (3) IgA endomysial, (4) IgA, and (5) IgG anti-deamidated gliadin peptides, (6) dual detection of IgA and IgG anti-deamidated gliadin peptides, (7) a single assay for IgA and IgG of both anti-deamidated gliadin peptide and anti-tissue transglutaminase, and (8) IgA antiactin antibodies.

Results

At 3 months after diagnosis, most antibody assays significant decrease in mean concentrations (p < 0.0001) and the percentage of positive samples (p < 0.0001) with further improvement in subsequent determinations. Strictly adherents had significantly lower concentrations of antibodies (p < 0.01 to p < 0.00001) and smaller proportion of positive samples for IgA endomysial, IgA antiactin antibodies and IgA antigliadin (15.6%, 17.4% and 23.9%, respectively) than partially compliant. At 1 year, IgA endomysial (p < 0.02), IgA antiactin antibodies (p < 0.05) and anti-tissue transglutaminase (p < 0.02) predicted the degree of compliance.

Conclusions

Gluten-free diet treatment produced rapid and significant qualitative and quantitative changes in celiac disease-related antibodies which may be useful for monitoring dietary compliance.

Introduction

Celiac disease (CD) is a chronic inflammatory disease in the gastrointestinal (GI) tract triggered by dietary gluten in susceptible individuals. Complete and lifelong adherence to a gluten-free diet (GFD) is the only accepted treatment that allows patients to lead an otherwise normal life [1], [2], [3]. The current diagnostic strategy for CD is primarily based on the demonstration of a characteristic gluten-dependent enteropathy [1], [2]. Whilst intestinal biopsy is still considered the gold standard for diagnosing CD, CD-related serological tests have been used clinically for more than 20 years as markers for screening candidates for duodenal biopsy and as a reliable surrogate marker for gluten sensitivity [3]. Two types of antibodies have been closely associated with CD: the first type are the serum antibodies against gliadin, the external antigen that triggers CD [4], [5]; the other type are the autoantibodies against connective matrix proteins (anti-reticulin, anti-endomysium [EmA], anti-transglutaminase [a-tTG] and anti-actin antibodies [AAA]) [6], [7], [8].

Although the screening and diagnosis of CD is relatively well established [1], [9], there are no reliable measurements for follow-up assessment of treatment effectiveness [10], [11], [12], [13], [14]. Clinical assessment is not particularly useful to measure outcomes because a majority of patients with CD have an atypical or silent presentation of the illness [15]. The quality-of-life measurements have been shown to be responsive to treatment, but their sensitivity to patients’ compliance with dietary treatment seems to be limited [16]. Histological evaluation of duodenal biopsy specimens is critical for diagnosis, but is not feasible for routine monitoring of treatment efficacy and remission [14]. Although CD-specific serology has an established role in screening and diagnosis, their sensitivity and accuracy as an outcome measurement tool have not been well established and continue to be debated [15], [16], [17], [18], [19], [20].

Our aims in the present study were to prospectively describe the changes of a series of CD-related antibodies over time in newly diagnosed patients who were placed on the GFD and to determine the efficacy of serologic tests in evaluating patient compliance with dietary treatment during the first year of initiating the GFD.

Section snippets

Patients

From December 2004 to December 2005, 132 consecutive adults (113 female and 19 male) who were newly diagnosed for CD at the Small Bowel Diseases Clinic of the “Dr. Carlos Bonorino Udaondo” Gastroenterology Hospital were enrolled in this 1-year prospective study. IgA-deficient patients, those without biopsy-confirmed CD, and patients already on a GFD at the time of the first visit were excluded. We also excluded patients who expressed reluctance about participating to the study and those who

Baseline clinical and serologic findings

At diagnosis, most patients enrolled had classical GI symptoms, 19% had atypical presentation, and only 7% were asymptomatic. Table 1 presents demographic, clinical, and histological characteristics of patients at diagnosis.

The CD-specific serologic tests produced a range of baseline values depending on the assay used. Based on the cut-off values provided by the manufacturers, the serologic tests were categorised into assays with very high sensitivity (>92%) (IgA a-tTG, IgA, IgG a-DGP, IgA EmA,

Discussion

Avoidance of gluten exposure is crucial for CD patients to reduce the risk of complications. To achieve efficay with GFD, reliable markers are needed to monitor patient compliance with dietary restrictions. Clinical outcome, laboratory tests, quality-of-life instruments, self-reported compliance, intestinal biopsy, and others tools have been used with unsatisfactory reliability [3]. In contrast, a nutritionist's evaluation to estimate the degree of transgression from the GFD has been suggested

Conflict of interest statement

None declared.

Disclosures

This is an investigator-performed study and Inova Diagnostic Inc. had no direct or indirect involvement in the design of the study, data collection nor preparation or submission of the manuscript. Inova Diagnostic Inc. generously provided assays.

Grant/funding support

The study was supported by a grant from the Consejo de Investigaciones en Salud del Gobierno Autónomo de la Ciudad de Buenos Aires, Argentina. Reagents used in this study were generously provided by Inova Inc. San Diego, CA, USA.

References (32)

  • K. Rostami et al.

    Sensitivity of antiendomysium and antigliadin antibodies in untreated celiac disease: disappointing in clinical practice

    Am J Gastroenterol

    (1999)
  • E. Bazzigaluppi et al.

    Antibodies to recombinant human tissue-transglutaminase in coelic disease: diagnostic effectiveness and decline pattern after gluten-free diet

    Dig Liver Dis

    (2006)
  • C. Ciacci et al.

    The use of serum tTG-ab assay in patients on gluten-free diet as a measure of dietary compliance

    Gastroenterology

    (2002)
  • A. Carroccio et al.

    IgA anti-actin antibodies ELISA in coeliac disease: a multicentre study

    Dig Liv Dis

    (2007)
  • E. Sugai et al.

    Accuracy of testing for antibodies to synthetic gliadin-related peptides in celiac disease

    Clin Gastroenterol Hepatol

    (2006)
  • American Gastroenterological Association (AGA)

    Institute Technical Review on the Diagnosis and Management of Celiac Disease

    Gastroenterology

    (2006)
  • Cited by (83)

    • Nutrition Assessment, Interventions, and Monitoring for Patients with Celiac Disease: An Evidence Analysis Center Scoping Review

      2020, Journal of the Academy of Nutrition and Dietetics
      Citation Excerpt :

      One systematic review/meta-analysis281 examined the sensitivity and specificity of serum transglutaminase and endomysial antibodies on detecting patients with villous atrophy (Table 2). There were 21 original studies33,141,282-300 investigating the effectiveness of different tools/measures, such as immunoglobulin G anti-tissue deamidated gliadin peptides and immunoglobulin A anti-tissue transglutaminase, on monitoring adherence/compliance. Nine studies282-284,286,289,291,293,295,297 focused on adults, six studies33,141,287,288,294,298 focused on children, and six studies285,290,292,296,299,300 included on both age groups (Table 3).

    • Celiac Disease

      2019, Mayo Clinic Proceedings
    View all citing articles on Scopus
    View full text