On the horizon: Fecal testing for dietary compliance

[squirmingitch]

It looks like it won't be too long before we have a new method of testing for dietary compliance and it appears it's going to be more accurate/sensitive than the present serum tests.

At this link, there is an interview with Ivor D. Hill, MD, MB ChB; Alessio Fasano, MD.

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I would point you to page 4 of that. Some of you may not be able to access the linked page. You can sign up for Medscape, it's free and that's what I did, then you can access all of their articles.

The following is part of what both Dr. Hill said and what Dr. Fasano said:

Dr. Hill:

A very interesting paper has just come out in the American Journal of Gastroenterology,^[4]in which a group from Spain looked at gluten immunogenic peptides in the stool and documented that you can actually identify these in the stool. People think that, based on dietary review, they are completely gluten free. That may be something in the future that will give us a very good test, and I am excited about the possibility that we will actually be able to detect gluten immunogenic peptides in the stool and know that the patient is still being exposed, as opposed to relying on dietary review, symptoms, and TTG testing.

 

Dr Fasano: To echo what Ivor has said, we do have a concern. The same Spanish group presented a follow-up of evidence of the robust performance of this test for immunogenic peptides in stool at the World Congress in Montreal.^[5] I am as impressed as Ivor that this might be a very objective, strong way to monitor for inadvertent exposure to gluten.

 

Here are links to the studies they are referring to and the results:

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[Gemini]

I think this might be a good idea for those who do not trip antibody blood testing.  However, I noticed that Dr. Hill made the remark: "as opposed to relying on dietary review, symptoms, and TTG testing."  You do not use tTg as a test for dietary compliance. We all know you have to do a repeat DGP, in those who were diagnosed using blood antibody testing. DGP is pretty damn sensitive so why they keep omitting this is beyond me.    Personally, I would rather have a blood draw than do stool testing but I do agree this would be great for a certain subset of Celiac patients.

[ravenwoodglass]

I wonder if this might have diagnostic use at some point. It would be nice to have a way to diagnose without a challenge for those that are already gluten free.  Also wonder if this is similar to the fecal testng that Enterolab does.

[squirmingitch]

I agree Gem, I would rather have a blood draw but yes, there are those who don't test positive on the serum.

I don't know if Dr. Hill just screwed up when he said TTG or if that was a typo. It could easily be either. I am astounded beyond measure at the amount of typos in the professional world these days. It seems everything you read has at least a couple. The incorrect grammar is appalling! No one proofreads anymore. That's one thing when it's something casual but something entirely different when it's journalism or a professional article.

[cyclinglady]

I'm going to hope for a gluten-sniffing dog!  Funny, my 5th grader's science project was about cancer sniffing dogs.  During her presentation, she used our labrador to demonstrate.  She trained our dog to identify food masking as "cancer cells".  It was hilarious!  Our dog actually did it!  

Anyway, I can't agree more with Gemini about the TTG measuring dietary compliance.  I continue to test negative to the TTG.   I think the DGP should be included in helping to determine dietary compliance.  

Finally, I was saddened to hear that Dr. Fasano's recent research showed that some 20% of children are not experiencing intestinal healing.  We know from other studies that some 2/3 of  adult celiac patients never heal.  It is disheartening!  More post-diagnosis research and better tools to manage celiac disease are desperately needed.  

[squirmingitch]

3 hours ago, ravenwoodglass said:

I wonder if this might have diagnostic use at some point. It would be nice to have a way to diagnose without a challenge for those that are already gluten free.  Also wonder if this is similar to the fecal testng that Enterolab does.

I don't think so Raven. This is detecting the peptide in gluten not antibodies against gluten.