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  • Jefferson Adams
    Jefferson Adams

    A Breath Test for Celiac Disease? Yes Please!

    Reviewed and edited by a celiac disease expert.

      Scientific paper has more than a few people excited about a breakthrough breath test to help manage diabetes, celiac disease and other conditions.


    Caption: Image: CC--Bread for the World

    Celiac.com 05/20/2019 - A stuffy and obscure-sounding scientific paper has more than a few people excited about a breakthrough breath test to help manage diabetes, celiac disease and other conditions.

    Celiac is one of the most common and misdiagnosed disease. The process of getting a proper diagnosis can be long and convoluted. In part, that's because people with celiac disease may have few or no symptoms. In fact, these days, most people diagnosed with celiac disease report few or no symptoms.

    In fact, it's not at all uncommon for a person with celiac disease to suffer for up to 10 years before getting a proper celiac diagnosis.

    In diabetes, glucagon increases blood glucose levels. In diabetes treatment, DPP-4 inhibitors are used to reduce glucagon and blood glucose levels.  According to Wikipedia, they do this by increasing levels of incretin, GLP-1 and GIP, "which inhibit glucagon release, which in turn increases insulin secretion, decreases gastric emptying, and decreases blood glucose levels."

    The excitement arrises because a team of scientists has developed a selective, non-invasive breath test that could be used to diagnose and treat celiac disease and Type-II diabetes.

    The development team set out to develop a selective, non-invasive, stable-isotope 13C-breath test that can detect dipeptidyl peptidase-4 inhibitors (DPP4i), a class of orally available, small molecule inhibitors for the management of Type-II diabetes. 

    The team included Roger Yazbeck, Simone Jaenisch, Michelle Squire, Catherine A. Abbott, Emma Parkinson-Lawrence, Douglas A. Brooks & Ross N. Butler. The team's paper carries the very weighty title: Development of a 13C Stable Isotope Assay for Dipeptidyl Peptidase-4 Enzyme Activity A New Breath Test for Dipeptidyl Peptidase Activity.

    If you read that title, and understood only the words "breath test," you are not alone. The title and the paper are highly scientific. The takeaway is that the test they developed could be useful in diagnosing, treating, and managing diabetes and gastrointestinal diseases, including celiac disease.

    The team's paper describes in detail their development process for the stable-isotope 13C-breath test for DPP4. The test could potentially help to treat and manage diabetes, celiac disease, and other conditions, including certain cancers.

    "Furthermore," the paper reads "the significant pool of DPP4 in the small bowel and in inflammatory conditions suggests that a DPP4 breath test could also have potential application as a non-invasive method to measure intestinal function/integrity and immune status. Certain cancers also exhibit high expression of DPP4 as exemplified by the adenocarcinoma cell line in this study and this may provide a measure of cancer activity and response to therapy."

    Imagine a quick non-invasive breath test that can do all that. That's exciting stuff. Among other things, it could mean better treatment, and less unnecessary suffering. We say: Yes, please!

    Do you find the idea of a breath test for diabetes and celiac disease an exciting prospect? Share comments below.

    Read more in Nature.com Scientific Reports; volume 9, Article number: 4906 (2019.

    Also of interest is D Detel, M Persic, & J Varljen's paper titled "Serum and intestinal dipeptidyl peptidase IV (DPP IV/CD26) activity in children with celiac disease," and published in the Journal of Pediatric Gastroenterology and Nutrition; 45, 65–70


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    First- by making it easier and less invasive to test for Celiac or diabetes- it will  lead to more diagnoses of Celiac - that can then be treated.  And It sounds like they could use it to help check compliance and healing of Celiac.  It doesn’t say it replaces a gluten-free diet or insulin in a diabetic.  

    Edited by kareng

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    45 minutes ago, kareng said:

    First- by making it easier and less invasive to test for Celiac or diabetes- it will  lead to more diagnoses of Celiac - that can then be treated.  And It sounds like they could use it to help check compliance and healing of Celiac.  It doesn’t say it replaces a gluten-free diet or insulin in a diabetic.  

    Aren't the antibody tests more specific for Celiac? What would this test add to them?

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    The breath test would be done to diagnose not treat according to the article above I am curious however ,whether it could diagnose celiac without eating the foods.I am a recently retired nurse and diagnosed with an allergy to gluten not sensitivity by an ENT specialist .It affected my sinuses severely .The bloating only came once i was eating high carbs while I was on a very high dose of oral steroids .I have a picture where I look ready to deliver a child full term.I have one sibling with a wheat allergy another with a gluten sensitivity and as well  2  distant cousins with wheat allergies.My siblings and I were off gluten before we had testing done as things were  too bad to continue eating it

    So we have no way of knowing if we all have celiac disease.Here's hoping!

     

     

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    The article does say to diagnose and treat celiac disease.

    Quote / "The excitement arrises because a team of scientists has developed a selective, non-invasive breath test that could be used to diagnose and treat celiac disease and Type-II diabetes."  // Unquote

    I assume they mean to diagnose and monitor celiac disease though.

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    Monitoring if a treatment works is part of "the treatment".   If you break your leg, part of "treating" the leg is repeat xrays (to see how its doing in the cast).  By the logic that this one "guest" keeps repeating, then a followup xray to decide to take off the cast is not part of the treatment?

      Seems a silly thing to quibble about if there is an easier way to diagnose any disease.  

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    Guest ANTHONY COLATRELLA

    Posted

    Mr. J.A. erred in his explanation of the test---it was developed to detect DPP enzyme activity---NOT DDPi(inhibitor) activity---DPPi is the class of drugs used to treat type2Diabetes---it would seem the main use of this test would be to measure DPP activity AFTER ingestion of DPPi to see if the drug would be effective, since that is how the drug works by inhibiting DPP so it does not inactivate GLP and GIP allowing these hormones to counteract glucagon. I cannot see how it applies to Celiac disease---either diagnostically or therapeutically---in fact the other article referenced which is from 2006--found no difference in intestinal levels of DPP in patients with celiac disease or other malabsorption syndromes---and presumably this is what the breath test is measuring-- intestinal levels of DPP.  There also was no difference in serum levels of DPP among the Celiacs, the MAS, and controls    Interestingly most of the OTC so called "digestive enzymes" which claim to digest gluten and advertised to help people with problems with gluten( but with the disclaimer--"NOT INTENDED TO TREAT CELIAC DISEASE"-since that would make it a drug and subject to FDA regulations instead of a "SUPPLEMENT" which is unregulated----most of these contain DPP as their active ingredient---DPP=dipeptidyl protenase---an enzyme that can digest proteins like gluten--------  unfortunately when subjected to legitimate scientific testing DPP does NOT effectively digest gliadin peptides which initiate celiac disease--so such products are of no help to celiacs.  Maybe after further work other applications of this test will become clearer 

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    Guest ANTHONY COLATRELLA

    Posted

    As an addendum to my prior comments above, I went back and read the entire article describing this test---I am not at all sure how well versed in celiac disease the authors are----they state that DPP has recently been implicated in the pathogenesis of celiac disease!------the 2 references they give #s 27 and 28 are from 1990 and 1994---we have certainly found out a great deal about the pathogenesis of celiac disease since then and it has nothing to do with DPP! Then seemingly in support of their test they refer to the same article(#29) from 2006 that was referenced by JA at the end of his article reporting on the test---which as I already stated above did NOT seem to find DPP levels helpful.   The one area where I can see it may potentially be helpful would be in a patient with KNOWN celiac disease after being on a GFD for 1-2yrs to check for DPP levels---if WNL it would indicate mucosal recovery----you would need to get a baseline when first diagnosed and then the repeat later to see if the DPP had recovered---this would be in place of repeating the SB biopsy.  It would seem to me this would still require much work to see if such measurements accurately correlate with mucosal recovery.

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, science, and advanced research, and scientific methods. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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