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Part 2 - The Sorbitol H2-breath Test
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Scand J Gastroenterol. 2003 Jul;38(7):727-31.
Effectiveness of the sorbitol H2 breath test in detecting histological
damage among relatives of coeliacs.
Tursi A, Brandimarte G, Giorgetti GM, Inchingolo CD.
Dept. of Emergency, L. Bonomo Hospital, Andria (BA), Italy.
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BACKGROUND: Small intestinal lesions have a wide severity in coeliac
disease (CD), and early diagnosis is important in preventing neoplastic and
non-neoplastic disorders related to CD. The aim of this study was to
compare the effectiveness of the sorbitol H2 breath test (H2-BT) and
serological tests (antigliadin (AGA), antiendomysium (EMA) and anti-tissue
transglutaminase (anti-tTG)) as screening tests in the detection and
estimation of CD prevalence in 1st-degree relatives. METHODS: Screening was
performed in 111 1st-degree relatives of 37 coeliac families. Sorbitol H2-
BT, AGA, EMA and anti-tTG antibodies were used to select the candidates for
small-bowel biopsy. Relatives with abnormal serological tests and/or with
sorbitol H2-BT positivity underwent a small-bowel biopsy. Small-bowel
biopsy was also performed in relatives negative in all tests but with
clinical complaints or suspected of having CD, and intestinal lesions were
expressed according to the Marsh classification. RESULTS: CD was diagnosed
in 49/111 screened relatives (44.14%): 5 showed Marsh IIIc, 8 Marsh IIIb,
16 Marsh IIIa, 13 Marsh II and 7 Marsh I lesions. Nineteen relatives showed
the classical form of the disease, while the subclinical and silent forms
were recorded in 20 and 10, respectively. AGA, EMA and anti-tTG showed
strong positivity only in severe intestinal damage (Marsh IIIb-c lesions)
(but overall positivity was 36.73%, 38.78% and 44.89% for AGA, EMA and anti-
tTG, respectively), while sorbitol H2-BT showed strong positivity also in
patients with slight histological damage (Marsh I-IIIa) (overall positivity
was 83.67%). CONCLUSIONS: A significant proportion of coeliacs may be
missed if relatives are screened by serology only, while the efficacy of
sorbitol H2-BT in screening relatives is confirmed. This study confirms
that neither a breath test nor serology can replace intestinal biopsy,
which remains the gold standard for the diagnosis of CD.
PMID: 12889558 [PubMed - indexed for MEDLINE]
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J Clin Gastroenterol. 2003 Nov-Dec;37(5):387-91.
Lack of usefulness of anti-transglutaminase antibodies in assessing
histologic recovery after gluten-free diet in celiac disease.
Tursi A, Brandimarte G, Giorgetti GM.
Department of Emergency, "L. Bonomo" Hospital, Andria, Italy.
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Gluten-free diet (GFD) plays a key role in the treatment of celiac disease
(CD), but it is difficult to evaluate the effect of GFD on the improvement
of villous architecture using sensitive, non-invasive tests. Aim of this
study is to evaluate anti-transglutaminase (tTG) antibodies in the follow-
up of CD to detect histologic recovery. We studied 42 consecutive patients
with CD. In all the patients anti-tTG antibodies (evaluated by the enzyme
linked immunosorbent assay method) and EGDscopy with multiple bioptic
samples before GFD and then 6, 12, and 18 months after GFD were evaluated.
For comparison, a sorbitol H2-breath test (H2-BT) and anti-endomysium (EMA)
antibodies test were carried out concomitantly. Anti-tTG results were
positive in 36 of 42 patients before GFD (80.95%), while they were positive
in 11 of 34 (32.35%), 1 of 17 (5.88%), and 0 of 6 (0%) of patients with a
persistence in histologic lesions 6, 12, and 18 months of GFD respectively,
without any correlation with persistence of histologic lesions (P = NS).
Also EMA failed to show correlation with improvement of histologic lesions.
They were positive in 31 of 42 patients before GFD (73.80%), while they
were positive in 18 of 34 (52.94%), 3 of 17 (17.64%), and 0 of 6 (0%) cases
6, 12, and 18 months of GFD respectively (P = NS). Regarding sorbitol H2-
BT, it was positive in 40 of 42 (95.24%) patients before GFD, while it was
positive in 31 of 34 (91.17%), 13 of 17 (76.47%), and 4 of 6 (50%) of
patients with a persistence in histologic lesions 6, 12, and then 18 months
after GFD starting (see Fig. 2, infra). So, anti-tTG and EMA were
ineffective in assessing the histologic recovery at each follow-up visit (P
= NS), while sorbitol H2-BT seems more effective than anti-tTG and EMA in
this field (P < 0.0001 sorbitol H2-BT versus anti-tTG and versus EMA at 18
months after gluten withdrawal). Thirty-eight of 42 (90.47%) patients
adhered to a strict GFD. Four patients were found to have occasional
dietary transgression, and in all we noted a progressive decreasing of anti-
tTG after 6 months of GFD and negative anti-tTG after 12 months of GFD, but
sorbitol H2-BT persisted being positive during the entire follow-up.
Intestinal damage persisted during the follow-up, despite anti-tTG and EMA
negativity, and worsened in the presence of dietary lapses. Anti-tTG does
not seem effective to assess histologic recovery in the follow-up of celiac
patients after they have started GFD due to its poor correlation with
histologic damage.
PMID: 14564185 [PubMed - indexed for MEDLINE]
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