Evaluation of adherence to the gluten-free diet in adolescent and adult patients with coeliac disease: a strategy based on the determination of gluten immunogenic peptides endorsed by the Spanish Society of Coeliac Disease (SEEC)

Adherence to a gluten-free diet (GFD) is the only treatment for patients with celiac disease (CD) with non-compliance rates higher than 60% and 55% of patients with persistent atrophy related to inadvertent gluten exposure. The main scientific societies recommend a periodic annual or biennial evaluation with nutritional assessment, dietary record and specific laboratory and serological tests to assess adherence to GFD, symptoms and complications. Most patients on GFD are asymptomatic with negative serology, but the determination of gluten immunogenic peptides (GIP) in stool is positive in 77% of them. A protocolized follow-up with GIP determination will improve adherence and mucosal healing. This protocol focuses on the GIP management strategy in the follow-up of CD patients to monitor adherence to DSG and make decisions based on the results.