A Canadian Study toward Changing Local Practice in the Diagnosis of Pediatric Celiac Disease

Area of Science:

• Pediatric Gastroenterology
• Immunology
• Celiac Disease Diagnostics

Background:

• European Society for Pediatric Gastroenterology, Hepatology and Nutrition recommends serological diagnosis (SD) for pediatric celiac disease (CD).
• This study pilots SD and evaluates gastrointestinal permeability and mucosal inflammation.
• Hypothesis: SD yields similar short-term outcomes as endoscopic diagnosis (ED).

Purpose of the Study:

• To pilot serological diagnosis (SD) for pediatric celiac disease (CD).
• To prospectively evaluate gastrointestinal permeability and mucosal inflammation.
• To compare outcomes between SD and endoscopic diagnosis (ED) after one year on a gluten-free diet (GFD).

Main Methods:

• Children aged 3-17 with suspected CD were eligible for SD if anti-tissue transglutaminase (aTTG) levels were ≥200 U/mL, confirmed by repeat aTTG and HLA.
• Gastrointestinal permeability assessed using sugar probes (lactulose:mannitol ratio [L:M], fractional excretion of sucrose [%FES]).
• Mucosal inflammation assessed using fecal calprotectin (FC) at baseline and after one year on GFD, compared to ED patients.

Main Results:

• No significant differences in baseline L:M, %FES, or FC between SD (n=40) and ED (n=48) groups.
• At follow-up, both groups showed improved intestinal permeability (L:M, %FES) and were similar.
• FC improved in both groups, but remained higher in the SD group (p=0.04).

Conclusions:

• Patients on a gluten-free diet (GFD) demonstrate improved intestinal permeability and mucosal inflammation irrespective of diagnostic strategy.
• This study supports the use of serological diagnosis (SD) in children with celiac disease (CD).
• Children diagnosed by SD show early resolution of mucosal disease after initiating a GFD.