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Analysis of gluten immunogenic peptides in feces to assess adherence to the gluten-free diet in pediatric celiac patients



In celiac disease (CD) there is a need for precise and non-invasive tools to assess dietary compliance to the gluten-free diet (GFD). Our aim is to evaluate the efficacy of the detection of gluten immunogenic peptides (GIP) in feces, to monitor in real life, the adherence to GFD in pediatric patients with CD.


A cross-sectional, prospective study was conducted. Fecal samples from CD children were analyzed by a rapid immunochromatographic (IC) test and by an ELISA method, both based on the antigliadin 33-mer monoclonal antibody.


Group 1 comprises 43 children on a GFD. According to the food records (FR), 39/43 patients were compliant with the GFD and gluten consumption was recorded in 4. GIP were detected in 15/43 individuals by the ELISA method and also in 7 by IC strips. Group 2: comprise 18 children at CD diagnosis; GIP levels decreased over time (p < 0.001) in a non-linear way (p = 0.028) after starting a GFD and were below the detection limit on the third day in most individuals.


GIP were detected, both by ELISA and by IC strips, in CD patients on a GFD, in which no consumption of gluten had been registered on the FR, confirming GIP detection to be superior to FR discovering involuntary transgressions. Despite a positive correlation between the amount of gluten intake and the concentration of GIP in feces, the interindividual variations observed suggest gastrointestinal factors influencing GIP recovery need to be further investigated.

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Fig. 5



Anti-tissue transglutaminase antibodies


Celiac disease


Confidence interval


Sandwich enzyme-linked immunosorbent


European Society for Paediatric Gastroenterology, Hepatology and Nutrition


Food record


Gluten-free diet


Gluten immunogenic peptides


Gluten-free products

IC test:

Immunochromatographic test


Pediatric Gastroenterology Unit


Standard deviation


Upper limit of normal


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We thank all the families who participated in this study. The authors are grateful for the professional English language editing by Sara Carrasco.


This study was partially supported by grant from the Coeliac Disease & Gluten Sensitivity Association Madrid, Spain.

Author information




MR and CRK have contributed to the conception and design of the study; MR, ED, EM, PC, VF, BP and CRK have contributed to the acquisition, analysis or interpretation of data, MR, ED, EM, PC and CRK have contributed to drafting the manuscript. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to María Roca.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical statement

The Ethical Committee of University and Polytechnic La Fe Hospital reviewed and approved this study in 2015.

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Roca, M., Donat, E., Masip, E. et al. Analysis of gluten immunogenic peptides in feces to assess adherence to the gluten-free diet in pediatric celiac patients. Eur J Nutr 60, 2131–2140 (2021).

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  • Celiac disease
  • Gluten-free diet
  • Gluten immunogenic peptides