Is detection of GIP a milestone in the history of Celiac Disease?

In the history of Celiac Disease, different stages delimited by various advances in diagnosis and its etiopathogenesis can be considered. Likewise, within these stages, can be highlighted a series of milestones and discoveries for diagnosis, follow-up and treatment of the disease.

Evolution and milestones of Celiac Disease

Some important milestones in the history of Celiac Disease are worthy of mention: recognition of the main haplotypes linked to the disease (HLA-DQ2.5 and HLA-DQ8), identification of TG2 as an autoantigen and determination of IgA TG2 antibodies as a biomarker of disease in untreated celiacs.

However, one of the most relevant advances in the treatment of Celiac Disease to date has been the identification of the role of gluten in the perpetuation of this condition. To such an extent that the only existing treatment for this condition consists of strictly following the Gluten Free Diet.

– Dicke and the beginning of Gluten Free Diet

In the 1940s, in the context of the Second World War, foods containing wheat were scarce and the potato entered, replacing it, which made gluten disappear from the scene. Then, Dicke, a Dutch pediatrician, realized that patients with Celiac Disease presented improvement when they followed a diet with no wheat flour, confirming the suitability of a diet without wheat in people with Celiac Disease.

– Gluten Free Diet Monitoring

From the 1960s to the present, milestones as relevant as notification of the reversal of the intestinal wall injury after following the Gluten-Free Diet, questioning of the usefulness of the follow-up biopsy or presence of intestinal damage in treated seronegative celiac patients. Later, in the 2000s, it is worth highlighting the development of tools that objectively detect gluten immunogenic peptides (GIP), fragments of gluten proteins that are resistant to gastrointestinal digestion and trigger immunological reactions in patients. celiacs. The identification of gluten peptides in urine, meant evidence that gluten fragments were able to pass the intestinal barrier, reach the blood circulation and even be excreted as other metabolic waste products, being the first food peptides detected in urine. 

Are GIPs the new milestone in celiac disease management?

Recent Statement of the Society for the Study of Celiac Disease on the gaps and opportunities of the same, published in Nature Reviews Gastroenterology & Hepatology, presents the detection of excreted GIP as one of the latest milestones in the history of Celiac Disease.

Due to the difficulty of following the Gluten Free Diet and the persistence of symptoms in treated celiacs, there is a growing need for adequate clinical management of the disease. Thus, new tools have been developed for the detection of gluten in order to improve the management of the disease. Currently, there are tests that detect the presence of GIP in feces and urine, thus facilitating treatment control, since non-compliance with the diet is the first cause of problems associated with diagnosed celiac disease.

Recent studies have confirmed that the obtaining of three negative results in urine of different days of a week, correlate with a recovered intestine or without atrophy. Thus, one of the challenges in this regard that remains to be achieved is the design of clinical guidelines for the integration of GIP detection tests in clinical use and follow-up.

In short, the passage of time has made it possible to detect and learn about Celiac Disease, benefits of the Gluten-Free Diet in people who suffer from it, as well as development of new tools to control gluten exposure and degree of adherence to the diet.

 

Reference: Pinto-Sanchez, M.I., Silvester, J.A., Lebwohl, B. et al. Society for the Study of Celiac Disease position statement on gaps and opportunities in coeliac disease. Nat Rev Gastroenterol Hepatol (2021). https://doi.org/10.1038/s41575-021-00511-8