Celiac.com 03/22/2013 - Enterocyte damage is one of the common features of celiac disease, and often results in malabsorption. Presently, doctors don't know very much about the recovery of enterocyte damage and its clinical consequences. Serum intestinal fatty acid binding protein (I-FABP) is a marker that allows researchers to study enterocyte damage.

Photo: CC--KezzeA research team set out to determine the severity of enterocyte damage in adult-onset celiac disease, how it responds to a gluten-free diet, and the correlation among enterocyte damage, celiac disease autoantibodies and histological abnormalities during the course of disease.

The research team included M. P. M. Adriaanse, G. J. Tack, V. Lima Passos, J. G. M. C. Damoiseaux, M. W. J. Schreurs, K. van Wijck, R. G. Riedl, A. A. M. Masclee, W. A. Buurman, C. J. J. Mulder, and A. C. E. Vreugdenhil. They are affiliated with the Department of Paediatrics & Nutrition and Toxicology Research Institute Maastricht (NUTRIM) at Maastricht University Medical Centre in Maastricht, the Netherlands.

For their study, the team first determined I-FABP blood levels in 96 biopsy-proven adults with celiac disease, and in 69 patients following a gluten-free diet. They used 141 individuals with normal antitissue transglutaminase antibody (IgA-tTG) levels as a control group.

They found that levels of I-FABP were related to the degree of villous atrophy (Marsh grade) and IgA-tTG. Patients with untreated celiac disease showed higher I-FABP levels (median 691 pg/mL) compared with control subjects (median 178 pg/mL, P < 0.001) and correlated with Marsh grade (r = 0.265, P < 0.05) and IgA-tTG (r = 0.403, P < 0.01).

I-FABP blood levels in patients following a gluten-free diet dropped substantially, but not within the range found in control subjects, even though they showed normalization of IgA-tTG levels and Marsh grade. Celiac patients with elevated I-FABP levels who did not respond to gluten-free diet showed persistent histological abnormalities.

The team's main finding was that enterocyte damage, as assessed by serum I-FABP, correlates with the severity of villous atrophy in celiac disease at the time of diagnosis.

Even though enterocyte damage improves upon treatment with a gluten-free diet, the majority of patients still show substantial enterocyte damage despite the absence of villous atrophy and low IgA-tTG levels.

Thus, they conclude that elevated I-FABP levels that do not respond to a gluten-free diet likely point to histological abnormalities and warrant further evaluation.

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