Clinical Gastroenterology and Hepatology
Volume 9, Issue 4 , Pages 320-325, April 2011

Natural History of Potential Celiac Disease in Children

  • Antonella Tosco

      Affiliations

    • Department of Pediatrics and European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, Italy
    • ,
  • Virginia Michela Salvati

      Affiliations

    • Hospital S. Maria dell'Olmo, Salerno, Italy
    • ,
  • Renata Auricchio

      Affiliations

    • Department of Pediatrics and European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, Italy
    • ,
  • Mariantonia Maglio

      Affiliations

    • Department of Pediatrics and European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, Italy
    • ,
  • Melissa Borrelli

      Affiliations

    • Department of Pediatrics and European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, Italy
    • ,
  • Anna Coruzzo

      Affiliations

    • Department of Pediatrics and European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, Italy
    • ,
  • Francesco Paparo

      Affiliations

    • Department of Pediatrics and European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, Italy
    • ,
  • Massimo Boffardi

      Affiliations

    • Hospital S. Maria dell'Olmo, Salerno, Italy
    • ,
  • Antonella Esposito

      Affiliations

    • Rheumatology Unit, University Federico II, Naples, Italy
    • ,
  • Grazia D'Adamo

      Affiliations

    • Hospital S. Maria dell'Olmo, Salerno, Italy
    • ,
  • Basilio Malamisura

      Affiliations

    • Department of Pediatrics and European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, Italy
    • Hospital S. Maria dell'Olmo, Salerno, Italy
    • ,
  • Luigi Greco

      Affiliations

    • Department of Pediatrics and European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, Italy
    • ,
  • Riccardo Troncone

      Affiliations

    • Department of Pediatrics and European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, Italy
    • Corresponding Author InformationReprint requests Address requests for reprints to: Prof Riccardo Troncone, MD, Department of Pediatrics, via S Pansini 5, I-80131 Naples, Italy. fax: +39 081 5469811

published online 20 September 2010.

Background & Aims

The presence of celiac disease-associated autoantibodies (antiendomysium and antitissue transglutaminase [anti-TG2]) with normal jejunal mucosa indicate potential celiac disease. We performed a prospective, 3-year cohort study to determine the natural history of potential celiac disease in children.

Methods

The study included 106 children with potential celiac disease, based on serology analysis and normal duodenal architecture. All but 2 carried the HLA-DQ2 and/or DQ8 haplotype. In all children, every 6 months, growth, nutritional parameters, celiac disease serology, and autoimmunity were investigated. In biopsies, γδ intraepithelial-, CD3-, and lamina propria CD25-positive cells were counted; duodenal deposits of anti-TG2 immunoglobulin A were detected. Biopsy analysis was repeated after 2 years on patients with persistent positive serology and/or symptoms.

Results

Celiac disease was detected primarily in first-degree relatives and patients with autoimmune disorders (40.6%). A gluten-free diet was prescribed to 20/106 patients because of symptoms, which were relieved in only 11. Eighty-nine of the 106 patients entered the follow-up study, with normal daily consumption of gluten. During the follow-up antibodies disappeared in 14.6% and fluctuated in 32.6%. Villous atrophy was observed in 12/39 patients (30.8%) who underwent a repeat biopsy.

Conclusions

Most children with potential celiac disease remain healthy. After 3 years, approximately 33% of patients develop villous atrophy. Intestinal deposits of anti-TG2 IgA identify children at risk for villous atrophy.

Keywords: Anti-TG2 IgA Intestinal Deposits, Gluten Sensitive Enteropathy, Gluten Free Diet, Anti-TG2 Antibodies

Abbreviations used in this paper: Ad-SoS, amplitude-dependent speed of sound, anti-TG2, antitissue transglutaminase 2, CD, celiac disease, EMA, anti-endomysial antibodies, GFD, gluten-free diet, HLA, human leukocyte antigen, IEL, intraepithelial lymphocyte, Ig, immunoglobulin, TCR, T-cell receptor

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 This article has an accompanying continuing medical education activity on page e36. Learning Objectives—At the end of this activity, the learner will understand the differences between potential and latent celiac disease and the natural history of the former.

 Conflicts of interest The authors disclose no conflicts.

 Funding This work was realized with grants from The Regional Network Project for Children and Adolescents affected by Celiac Disease, Campania Region, Italy.

PII: S1542-3565(10)00865-7

doi:10.1016/j.cgh.2010.09.006

Clinical Gastroenterology and Hepatology
Volume 9, Issue 4 , Pages 320-325, April 2011

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