Additional value of serum I-FABP levels for evaluating celiac disease activity in children.
OBJECTIVE
Addition of a non-invasive marker for intestinal damage to the currently used parameters for celiac disease activity (symptoms, serologic tests and biopsy) might further improve clinical management of celiac disease (CD). Intestinal fatty acid binding protein (I-FABP) is a cytosolic enterocyte protein and sensitive marker for enterocyte damage in the small intestine. We investigated whether serum I-FABP levels can reliably identify villous atrophy in children with a positive CD antibody screening. Moreover, the recovery of I-FABP levels after gluten free diet (GFD) was studied.


METHODS
I-FABP levels were analyzed retrospectively in 49 children with biopsy proven CD and in 19 patients with a positive screening but without histological confirmation of CD. Blood was collected before biopsy and repeatedly after the onset of GFD.


RESULTS
Initial I-FABP concentrations in CD (median 458 pg/ml) were significantly (p < 0.001) elevated compared to controls (median 20 pg/ml). In the control group, only two of 19 children were found to have elevated I-FABP levels, of which one was subsequently diagnosed with CD after gluten challenge. I-FABP concentrations correlated with severity of villous atrophy. In all CD patients, I-FABP levels decreased quickly after GFD and normalized in 80% of patients within 12 weeks.


CONCLUSIONS
Elevated I-FABP levels accurately predict villous atrophy in children with a positive serologic test for CD (positive predictive value 98%). In addition, measurement of I-FABP enables monitoring the response to GFD.
Department of Pediatrics, Maastricht University Medical Center, Maastricht, Netherlands. A.Vreugdenhil@ah.unimaas.nl
Anita C
AC
Vreugdenhil
Victorien M
VM
Wolters
Marlou P
MP
Adriaanse
Anita M
AM
Van den Neucker
Annemarie A
AA
van Bijnen
Roderick
R
Houwen
Wim A
WA
Buurman
D000293:Adolescent; D019540:Area Under Curve; D001284:Atrophy / Q000473:pathology; D001706:Biopsy; D002446:Celiac Disease / Q000097:blood* / Q000178:diet therapy / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D055050:Diet, Gluten-Free; D020895:Enterocytes / Q000473:pathology* / Q000648:ultrastructure*; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D006801:Humans; D007223:Infant; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008871:Microvilli / Q000473:pathology; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index
D050556:Fatty Acid-Binding Proteins