Stool test beats urine for detecting hidden gluten in celiac patients
A new study shows stool analysis detects accidental gluten exposure in celiac disease patients with near-perfect accuracy, outperforming urine tests and symptom monitoring. The finding could reshape how patients and clinicians track dietary compliance, potentially improving long-term health outcomes and reducing complications from hidden gluten consumption.
Originaltitel: Stool gluten peptide detection is superior to urinary analysis, coeliac serology, dietary adherence scores and symptoms in the detection of intermittent gluten exposure in coeliac disease: a randomised, placebo-controlled, low-dose gluten challenge study
<p>Monitoring adherence to a gluten-free diet is an important goal of coeliac disease management. Urine and stool gluten immunogenic peptide (GIP) assays provide an objective readout of gluten ingestion, with the former favoured due to its convenience and acceptability. This study assessed stool GIP excretion after low-dose gluten challenge designed to mimic accidental gluten exposure. A total of 52 coeliac participants undertook a randomised, double-blind gluten (50–1000 mg) or placebo challenge. Stool and urinary GIP, serology, dietary adherence and symptoms were assessed. Stool GIP was 100% sensitive for gluten intake ≥250 mg and 71% for 50 mg. Peak GIP detection was 12–36 h after gluten exposure. The mean stool GIP after 1000 mg gluten ingestion remained above the limit of quantification for 5 days. Urine GIP assessment had poor sensitivity for GIP excretion compared to stool. Serology, dietary adherence score and symptoms did not correlate with gluten excretion during lead-in. We conclude that stool GIP detection is highly sensitive, with levels related to gluten dose and time from ingestion. Weekly or bi-weekly testing will detect low-level exposure more effectively than urine GIP assessments or traditional methods. In this seronegative, apparently well-treated cohort, a high frequency of baseline-positive GIP suggests ongoing gluten exposure, but the assessment of patient behaviour and assay specificity is needed.</p>