ArticleAlimentary pharmacology & therapeutics2020
Exposure sources, amounts and time course of gluten ingestion and excretion in patients with coeliac disease on a gluten-free diet.
Article in Alimentary pharmacology & therapeutics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
27 citing papers in PubMed, 1 synthesis or guideline pooled it, 64 citations in OpenAlex.
- Determination of gluten immunogenic peptides for the management of the treatment adherence of celiac disease: A systematic review.World journal of gastroenterology · 2021Pooled it
- Trial
- Low Levels of Detectable Urine and Stool GIPs in Children with Celiac Disease on a Gluten-Free Diet.JPGN reports · 2023Trial
- Testing for Faecal Gluten Immunogenic Peptides: Is It Useful to Evaluate Adherence to Gluten-Free Diet?Acta paediatrica (Oslo, Norway : 1992) · 2025Article
- Gluten-free diet adherence patterns and health outcomes in celiac disease: a retrospective observational study.BMC gastroenterology · 2025Observational
- Advances in the Prevention and Management of Celiac Disease.Nutrients · 2025Article
- Coeliac disease: complications and comorbidities.Nature reviews. Gastroenterology & hepatology · 2025Review
- Dietary assessments in individuals living with coeliac disease: key considerations.Journal of human nutrition and dietetics : the official journal of the British Dietetic Association · 2025Review
- Exploring factors influencing quality of life variability among individuals with coeliac disease: an online survey.BMJ open gastroenterology · 2024Article
- Tolerance-inducing therapies in coeliac disease - mechanisms, progress and future directions.Nature reviews. Gastroenterology & hepatology · 2024Review
- Gluten-Free Diet and Other Celiac Disease Therapies: Current Understanding and Emerging Strategies.Nutrients · 2024Review
- Guidelines for best practices in monitoring established coeliac disease in adult patients.Nature reviews. Gastroenterology & hepatology · 2024Review
- Transfer of celiac disease-associated immunogenic gluten peptides in breast milk: variability in kinetics of secretion.Frontiers in immunology · 2024Article
- Evaluation of a Single Determination of Gluten Immunogenic Peptides in Urine from Unaware Celiac Patients to Monitor Gluten-Free Diet Adherence.Nutrients · 2023Article
- Replacing the Burden of the Gluten Free Diet: Then, Now, and the Future.International journal of molecular sciences · 2022Review
- Celiac Disease in the Elderly.Current treatment options in gastroenterology · 2022Article
- Non-Responsive and Refractory Coeliac Disease: Experience from the NHS England National Centre.Nutrients · 2022Article
- Review article: Follow-up of coeliac disease.Alimentary pharmacology & therapeutics · 2022Review
- Individual variability in patterns and dynamics of fecal gluten immunogenic peptides excretion after low gluten intake.European journal of nutrition · 2022Article
- Application of a Platform for Gluten-Free Diet Evaluation and Dietary Advice: From Theory to Practice.Sensors (Basel, Switzerland) · 2022Article
Corrections and comments
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Authors and funding
15 authors at 7 institutions in 3 countries.
Funding
Abstract
backgroundA major deficit in understanding and improving treatment in coeliac disease (CD) is the lack of empiric data on real world gluten exposure.
aimsTo estimate gluten exposure on a gluten-free diet (GFD) using immunoassays for gluten immunogenic peptides (GIP) and to examine relationships among GIP detection, symptoms and suspected gluten exposures
methodsAdults with biopsy-confirmed CD on a GFD for 24 months were recruited from a population-based inception cohort. Participants kept a diary and collected urine samples for 10 days and stools on days 4-10. 'Doggie bags' containing ¼ portions of foods consumed were saved during the first 7 days. Gluten in food, stool and urine was quantified using A1/G12 ELISA.
resultsEighteen participants with CD (12 female; age 21-70 years) and three participants on a gluten-containing diet enrolled and completed the study. Twelve out of 18 CD participants had a median 2.1 mg gluten per exposure (range 0.2 to >80 mg). Most exposures were asymptomatic and unsuspected. There was high intra-individual variability in the interval between gluten ingestion and excretion. Participants were generally unable to identify the food.
conclusionsGluten exposure on a GFD is common, intermittent, and usually silent. Excretion kinetics are highly variable among individuals. The amount of gluten varied widely, but was typically in the milligram range, which was 10-100 times less than consumed by those on an unrestricted diet. These findings suggest that a strict GFD is difficult to attain, and specific exposures are difficult to detect due to variable time course of excretion.
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