--- title: "Prolyl endopeptidase: gluten-inducd malabsorptn celiac sprue | Sutter Health" description: "Pretreatment of gluten with PEP avoided the development of fat or carbohydrate malabsorption in the majority of those patients who developed fat or carbohydrate malabsorption after a 2-week gluten challenge." url: "https://www.sutterhealth.org/research/publications/prolyl-endopeptidase-gluten-malabsorp-celiac-sprue-1055312496" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Prolyl endopeptidase: gluten-inducd malabsorptn celiac sprue # Effect of pretreatment of food gluten with prolyl endopeptidase on gluten-induced malabsorption in celiac sprue. Pyle GG, Paaso B, Anderson BE, Allen DD, Marti T, Li Q, Siegel M, Khosla C, & Gray GM. _Clin Gastroenterol Hepatol. 3(7):687-94._ 2005-07-01 ## Abstract BACKGROUND & AIMS: We sought to determine whether prolyl endopeptidase (PEP) treatment of food gluten would obviate the intestinal dysfunction produced by small amounts of dietary gluten supplement in patients with celiac sprue. METHODS: Twenty asymptomatic patients with histologically proven celiac sprue completed a randomized, double-blind, cross-over study involving two 14-day stages. Each patient consumed a low dose of a gluten supplement daily (5 g; equivalent to 1 slice of bread) in 1 stage and gluten pretreated with PEP in the other stage. Patients completed a daily symptom questionnaire and a D-xylose urine excretion and a 72-hour quantitative fecal fat were monitored before and after each stage. RESULTS: Despite clinical remission at baseline, 40% of patients had at least 1 abnormal celiac antibody, 20% had an abnormal urine xylose, and 63% had an abnormal fecal fat test result. There was no difference in symptoms as a function of the type of gluten consumed. In response to gluten not treated with PEP, an appreciable proportion of patients developed malabsorption of fat (7 of 17, 41%) or xylose (8 of 14, 57%). When the gluten was pretreated with PEP, fat malabsorption was avoided in 5 of 7 and xylose malabsorption in 4 of 8 of these same patients. CONCLUSIONS: A significant proportion of asymptomatic patients with celiac sprue have abnormal celiac antibodies and fat or carbohydrate malabsorption. Pretreatment of gluten with PEP avoided the development of fat or carbohydrate malabsorption in the majority of those patients who developed fat or carbohydrate malabsorption after a 2-week gluten challenge. [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/16206502) ## Research topics - [Digestive Disorders](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Digestive+Disorders%5C%22%22) - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) - [Food and Nutrition](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Food+and+Nutrition%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Low-dose gluten challenge in celiac sprue: malabsorptive and antibody responses.](https://www.sutterhealth.org/research/publications/gluten-challge-celiac-sprue-response-1055312499) Pyle GG, Paaso B, Anderson BE, Allen D, Marti T, Khosla C, Gray GM. Clin Gastroenterol Hepatol. 3(7):679-86. 2005 Jul 01 - Publication ### [Dietary pattern change and acculturation of Chinese Americans in Pennsylvania.](https://www.sutterhealth.org/research/publications/diet-changes-and-acculturation-chinese-ams-in-pa-1055312864) Lv N, Cason KL. J Am Diet Assoc. 104(5):771-8. 2004 May 01 - Publication ### [Potential hazards of submucosal injection of methylene blue.](https://www.sutterhealth.org/research/publications/hazards-submucosal-injection-methylene-blue-1055312987) Chan EP, Kaltenbach T, Rouse RV, Soetikno R. Am J Gastroenterol. 107(4):633-4. doi: 10.1038/ajg.2011.462. 2012 Apr 01 - Publication ### [Nutrition myths and healthy dietary advice in clinical practice.](https://www.sutterhealth.org/research/publications/nutrition-myths-dietary-advice-clinical-practice-1055312828) Lesser LI, Mazza MC, Lucan SC. Am Fam Physician. 91(9):634-8. 2015 May 01 - Publication ### [Festival foods in the immigrant diet.](https://www.sutterhealth.org/research/publications/festival-foods-in-the-immigrant-diet-1055312568) Azar KM, Chen E, Holland AT, Palaniappan LP J Immigr Minor Health. 15(5):953-60. doi: 10.1007/s10903-012-9705-4 2013 Oct 15 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/prolyl-endopeptidase-gluten-malabsorp-celiac-sprue-1055312496#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Prolyl endopeptidase: gluten-inducd malabsorptn celiac sprue"}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/prolyl-endopeptidase-gluten-malabsorp-celiac-sprue-1055312496#medicalscholarlyarticle","name":"Effect of pretreatment of food gluten with prolyl endopeptidase on gluten-induced malabsorption in celiac sprue.","headline":"Prolyl endopeptidase: gluten-inducd malabsorptn celiac sprue","abstract":"BACKGROUND & AIMS: We sought to determine whether prolyl endopeptidase (PEP) treatment of food gluten would obviate the intestinal dysfunction produced by small amounts of dietary gluten supplement in patients with celiac sprue. METHODS: Twenty asymptomatic patients with histologically proven celiac sprue completed a randomized, double-blind, cross-over study involving two 14-day stages. Each patient consumed a low dose of a gluten supplement daily (5 g; equivalent to 1 slice of bread) in 1 stage and gluten pretreated with PEP in the other stage. Patients completed a daily symptom questionnaire and a D-xylose urine excretion and a 72-hour quantitative fecal fat were monitored before and after each stage. RESULTS: Despite clinical remission at baseline, 40% of patients had at least 1 abnormal celiac antibody, 20% had an abnormal urine xylose, and 63% had an abnormal fecal fat test result. There was no difference in symptoms as a function of the type of gluten consumed. In response to gluten not treated with PEP, an appreciable proportion of patients developed malabsorption of fat (7 of 17, 41%) or xylose (8 of 14, 57%). When the gluten was pretreated with PEP, fat malabsorption was avoided in 5 of 7 and xylose malabsorption in 4 of 8 of these same patients. CONCLUSIONS: A significant proportion of asymptomatic patients with celiac sprue have abnormal celiac antibodies and fat or carbohydrate malabsorption. Pretreatment of gluten with PEP avoided the development of fat or carbohydrate malabsorption in the majority of those patients who developed fat or carbohydrate malabsorption after a 2-week gluten challenge.","description":"Pretreatment of gluten with PEP avoided the development of fat or carbohydrate malabsorption in the majority of those patients who developed fat or carbohydrate malabsorption after a 2-week gluten challenge.","keywords":["Digestive Disorders","Disease Management","Food and Nutrition"],"datePublished":"2005-07-01","url":"https://www.sutterhealth.org/research/publications/prolyl-endopeptidase-gluten-malabsorp-celiac-sprue-1055312496","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"16206502"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/16206502/"],"isPartOf":{"@type":"Periodical","name":"Clin Gastroenterol Hepatol"},"author":[{"@type":"Person","name":"Pyle GG"},{"@type":"Person","name":"Paaso B"},{"@type":"Person","name":"Anderson BE"},{"@type":"Person","name":"Allen DD"},{"@type":"Person","name":"Marti T"},{"@type":"Person","name":"Li Q"},{"@type":"Person","name":"Siegel M"},{"@type":"Person","name":"Khosla C"},{"@type":"Person","name":"Gray GM"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Digestive Disorders","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Digestive+Disorders%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Disease Management","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Disease+Management%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Food and Nutrition","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Food+and+Nutrition%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/prolyl-endopeptidase-gluten-malabsorp-celiac-sprue-1055312496","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/prolyl-endopeptidase-gluten-malabsorp-celiac-sprue-1055312496#breadcrumblist"}}} ```