title: Intestinal permeability and antigliadin antibody test for monitoring adult patients with celiac disease.
abstract: Celiac disease causes chronic inflammation of the intestinal mucosa and reduces surface absorption; after the withdrawal of gluten from the diet, there are clinical and histologic improvements. The intestinal permeability test and serologic tests are useful for confirming the diagnosis and monitoring patients. The goal of this study is to compare the antigliadin antibody (AGA) test with the intestinal permeability test for celiac patients on a gluten-free diet. The sample consisted of 22 celiac patients who were antigliadin immunoglobulin A-positive before treatment. After 12 months on a gluten-free diet, AGA testing was repeated and the intestinal permeability test was performed. A control group was composed of 11 healthy individuals. AGA remained positive in 40.9% of celiac patients, and the mean urinary lactulose excretion was 10.27%, that of mannitol was 10.18%, and the lactulose/mannitol ratio was 1.02. In the subgroup in which antigliadin became negative (59.1%), the value for lactulose was 3.79%, that for mannitol was 11.12%, the lactulose/mannitol ratio was 0.38, and the p value was less than 0.0001, 0.66, and less than 0.0001, respectively. When the two celiac subgroups were compared with the control group, the urinary lactulose excretion and the lactulose/mannitol ratio was less in the control group, whereas urinary mannitol excretion was greater. The p values were less than 0.0001 for the three variables, suggesting persistent lesions in mucosa of both subgroups, although to a lesser degree for those that became AGA negative. It is concluded that intestinal permeability allows a more precise clinical physiopathologic correlation than antigliadin and offers more information for the monitoring of these patients.
authors.affiliation: Instituto Alfa de Gastroenterologia do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. evilela@medicina.ufmg.br
authors.forename: Eduardo Garcia
authors.initials: EG
authors.lastname: Vilela
authors.forename: Maria de Lourdes
authors.initials: Mde L
authors.lastname: de Abreu Ferrari
authors.forename: Henrique Osvaldo
authors.initials: HO
authors.lastname: de Gama Torres
authors.forename: Fabiana Paiva
authors.initials: FP
authors.lastname: Martins
authors.forename: Eugênio Marcos Andrade
authors.initials: EM
authors.lastname: Goulart
authors.forename: Agnaldo Soares
authors.initials: AS
authors.lastname: Lima
authors.forename: Aloíso Sales
authors.initials: AS
authors.lastname: da Cunha
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy / Q000276:immunology / Q000473:pathology / Q000652:urine; D018753:Diet, Protein-Restricted; D005260:Female; D005500:Follow-Up Studies; D005903:Gliadin / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D007408:Intestinal Absorption; D007792:Lactulose / Q000652:urine; D008297:Male; D008353:Mannitol / Q000652:urine; D008875:Middle Aged; D010539:Permeability; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007070:Immunoglobulin A; D008353:Mannitol; D007792:Lactulose; D005903:Gliadin