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Additional value of serum I-FABP levels for evaluating celiac disease activity in children
Anita C Vreugdenhil1, Victorien M Wolters, Marlou P Adriaanse
1Department of Pediatrics, Maastricht University Medical Center, Maastricht, Netherlands. A.Vreugdenhil@ah.unimaas.nl
Insights
Serum intestinal fatty acid binding protein (I-FABP) accurately predicts villous atrophy in children with celiac disease (CD). I-FABP levels also effectively monitor recovery during a gluten-free diet (GFD).
Area of Science:
- Gastroenterology
- Pediatric Gastroenterology
- Clinical Biomarkers
Background:
- Celiac disease (CD) management relies on symptoms, serology, and biopsy.
- A non-invasive marker for intestinal damage could enhance CD clinical management.
- Intestinal fatty acid binding protein (I-FABP) is a sensitive marker of small intestine enterocyte damage.
Purpose of the Study:
- To determine if serum I-FABP levels can reliably identify villous atrophy in children with positive CD antibody screening.
- To investigate the recovery of I-FABP levels following a gluten-free diet (GFD).
Main Methods:
- Retrospective analysis of serum I-FABP levels in 49 children with biopsy-proven CD and 19 controls.
- Blood samples collected before biopsy and repeatedly after GFD initiation.
- Correlation of I-FABP levels with villous atrophy severity and GFD response.
Main Results:
- Initial I-FABP concentrations were significantly elevated in CD patients (median 458 pg/ml) compared to controls (median 20 pg/ml).
- I-FABP levels correlated with the severity of villous atrophy.
- I-FABP levels decreased rapidly after GFD, normalizing in 80% of patients within 12 weeks.
Conclusions:
- Elevated serum I-FABP levels accurately predict villous atrophy in children with positive CD serology (98% positive predictive value).
- Serum I-FABP measurement is a valuable tool for monitoring treatment response to a GFD in pediatric celiac disease.
Objectives:
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.
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