title: Sorbitol H2-breath test versus anti-endomysium antibodies to assess histological recovery after gluten-free diet in coeliac disease.
abstract: BACKGROUND
  Gluten-free diet plays a key role in treatment of coeliac disease, but it is difficult to evaluate its effect on improvement of villous architecture using sensitive non-invasive tests.
  
  
  OBJECTIVE
  To compare sorbitol H2-Breath Test with antiendomysial antibodies in the follow-up of coeliac disease to detect histological recovery
  
  
  METHODS
  A total of 38 consecutive patients with coeliac disease were studied. All underwent Sorbitol H2-Breath Test, antiendomysial and oesophagogastroduodenoscopy with multiple bioptic samples before diet and then 6, 12 and 18 months after gluten-free diet. Expiratory samples were collected before patients drank the test solution (5 g sorbitol in 150 ml tap water) and thereafter every 30 min for 4 hours. An increase in H2 concentration of > or = 20 ppm above fasting baseline was considered positive for sorbitol malabsorption. Antiendomysial antibodies were evaluated by the indirect immunofluorescent method.
  
  
  RESULTS
  Antiendomysial antibodies were positive in 32/38 patients before gluten-free diet (84.21%), while they were positive in 20/34 (54.82%), 2/16 (12.5%) and 0/2 (0%) cases after 6, 12 and 18 months of gluten-free diet, respectively, no correlation being found with improvement of histological lesions (p = ns). As far as concerns sorbitol H2-Breath Test, maximal cut-off value (in ppm) decreased progressively and parallel to histological recovery during follow-up. Indeed, it decreased from a mean 63 ppm before diet to 35, 19 and 12 ppm, after 6, 12 and 18 months of gluten-free diet, with a stetistical difference being found before and after (p < 0.001). Likewise, the peak value (in minutes) appeared progressively later during follow-up, parallel to histological recovery. In fact, it appeared at a mean of 119 minutes before gluten-free diet, while it appears at a mean of 164, 195 and 219 minutes after 6, 12 and 18 months on gluten-free diet. A statistical difference before and after start of gluten-free diet was found also in this case (p < 0.001).
  
  
  CONCLUSIONS
  Sorbitol H2-Breath Test is better than antiendomysial antibodies in revealing histological recovery in the follow-up of coeliac patients after the start of gluten-free diet due to its good correlation with histological damage. Moreover, it also appears to be able to detect dietary mistakes of the patients on gluten-free diet.
authors.affiliation: Emergency Department "L. Bonomo" Hospital, Andria, BA, Italy. antotursi@tiscali.it
authors.forename: A
authors.initials: A
authors.lastname: Tursi
authors.forename: G
authors.initials: G
authors.lastname: Brandimarte
authors.forename: G M
authors.initials: GM
authors.lastname: Giorgetti
mesh_terms: D000293:Adolescent; D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D001944:Breath Tests; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy* / Q000276:immunology / Q000473:pathology; D004386:Duodenum / Q000473:pathology; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D006859:Hydrogen / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000276:immunology; D013012:Sorbitol
chemical_list: D001323:Autoantibodies; D013012:Sorbitol; D006859:Hydrogen