Quantification of Accidental Gluten Contamination in the Diet of Children with Treated Celiac Disease

Gluten-free diet adherence in pediatric celiac patients: Evaluating CDAT questionnaire and test for gluten detection in urine

OBJECTIVES

This study aimed to evaluate the contributions of the Adapted Celiac Dietary Adherence Test (CDAT) and the Rapid Urinary Gluten Detection Test (u-GIP) in assessing gluten-free diet adherence in children and adolescents with celiac disease.

METHODS

Fifty-four celiac patients from two pediatric gastroenterology outpatient clinics affiliated with university hospitals were evaluated. The original CDAT was adapted for children through a transcultural process, and the original cutoff point was adopted to define adherence. A single examiner carried out the u-GIP test in fresh urine samples. Sociodemographic and clinical factors and family food security status were also evaluated.

RESULTS

A total of 88.9% of participants (confidence interval [CI]: 77.4-95.8; p<0.001) adhered to the gluten-free diet, as determined by the adapted CDAT score, while 87.0% (CI: 75.1-94.6; p<0.001) had negative u-GIP results. Among the 48 children adhering to the CDAT, six exhibited positive u-GIP results in a urine sample. Of the six nonadherent participants, only one had a positive u-GIP result. Notably, none of the children and adolescents with celiac disease who tested positive for u-GIP reported symptoms on the day of testing, and their growth rates remained stable.

CONCLUSIONS

Even celiac children and adolescents adhering to the CDAT questionnaire may show a positive u-GIP in a single measurement without accompanying symptoms or growth impairment. The u-GIP could be helpful in complementary tests in specific situations, such as for patients who exhibit compliant behavior but still experience symptoms or maintain persistent positive serology.

Unauthentic Information About Celiac Disease on Social Networking Pages: Is It a Matter of Concern in Celiac Disease Management?

BACKGROUND

Facebook (FB) is the most popular online networking platform. Many celiac disease Facebook (CD-FB) pages spread awareness about celiac disease (CD). To get the latest information, patients with CD frequently follow such pages. However, little is known about whether such pages provide authentic and reliable information.

AIMS

This study aims to investigate whether CD-FB pages spread misleading information to patients with CD.

METHODS

On the Facebook social networking platform, CD-FB pages created in three celiac-prevalent countries (Italy, the USA, and India) were explored using different combinations of keywords. The type/category of the CD-FB page, country of origin, purpose, page web link, and number of followers/members were documented in a Microsoft spreadsheet. All posts distributed on selected CD-FB pages in the last 3 years were thoroughly screened.

RESULTS

From August 2022 to March 2023, a total of 200 CD-FB pages from Italy, the USA, and India were explored. Out of these 200 pages, 155 CD-FB (Italy 70; the USA 46; India 39) were found eligible. Of them, 20 (13%) CD-FB pages (Italy 4; the USA 5; India 11) shared misleading information about CD. Surprisingly, 11 (8%) of these 20 pages (Italy 0; the USA 2; India 9) supported alternative treatment options for CD.

CONCLUSIONS

CD-FB pages are useful for disseminating celiac-disease-related information. While most such pages provide useful information, 13% of CD-FB pages allow misleading information. Patients with CD should consult their treating unit before following any uncertain information posted on CD-FB pages.

Gluten-free diet for pediatric patients with coeliac disease: A position paper from the ESPGHAN gastroenterology committee, special interest group in coeliac disease

BACKGROUND AND OBJECTIVE

Coeliac disease is a chronic, immune-mediated disorder for which the only treatment consists of lifelong strict adherence to gluten-free diet (GFD). However, there is a lack of evidence-based guidelines on the GFD dietary management of coeliac disease. This position paper, led by the Special Interest Group in coeliac disease of the European Society of Pediatric, Gastroenterology Hepatology, and Nutrition, supported by the Nutrition Committee and the Allied Health Professionals Committee, aims to present evidence-based recommendations on the GFD as well as how to support dietary adherence.

METHODS

A wide literature search was performed using the MeSH Terms: "diet, gluten free," "gluten-free diet," "diets, gluten-free," "gluten free diet," and "coeliac disease" in Pubmed until November 8th, 2022.

RESULTS

The manuscript provides an overview of the definition of the GFD, regulations as basis to define the term "gluten-free," which foods are naturally gluten-free and gluten-containing. Moreover, it provides recommendations and educational tips and infographics on suitable food substitutes, the importance of reading food labels, risk of gluten cross-contact at home and in public settings, nutritional considerations as well as factors associated to dietary adherence based on available evidence, or otherwise clinical expertise.

CONCLUSIONS

This position paper provides guidance and recommendations to support children with coeliac disease to safely adhere to a GFD.

Molecular and in vivo studies of a glutamate-class prolyl-endopeptidase for coeliac disease therapy

The digestion of gluten generates toxic peptides, among which a highly immunogenic proline-rich 33-mer from wheat α-gliadin, that trigger coeliac disease. Neprosin from the pitcher plant is a reported prolyl endopeptidase. Here, we produce recombinant neprosin and its mutants, and find that full-length neprosin is a zymogen, which is self-activated at gastric pH by the release of an all-β pro-domain via a pH-switch mechanism featuring a lysine plug. The catalytic domain is an atypical 7+8-stranded β-sandwich with an extended active-site cleft containing an unprecedented pair of catalytic glutamates. Neprosin efficiently degrades both gliadin and the 33-mer in vitro under gastric conditions and is reversibly inactivated at pH > 5. Moreover, co-administration of gliadin and the neprosin zymogen at the ratio 500:1 reduces the abundance of the 33-mer in the small intestine of mice by up to 90%. Neprosin therefore founds a family of eukaryotic glutamate endopeptidases that fulfils requisites for a therapeutic glutenase.

Celiac disease is characterized by intolerance to gluten, a cereal protein. Here, the authors show that neprosin, a glutamate peptidase from the pitcher plant, efficiently cleaves gluten components under physiological conditions in vitro and in the gut of mice.