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Long-Term Outcome of Potential Celiac Disease in Genetically at-Risk Children: The Prospective CELIPREV Cohort Study
Elena Lionetti1, Stefania Castellaneta2, Ruggiero Francavilla3
1Department of Pediatrics, Marche Polytechnic University, 60123 Ancona, Italy. m.e.lionetti@univpm.it.com.
Insights
In children predisposed to celiac disease (CD), potential CD rarely progresses to overt CD over 10 years. Most children with potential CD on a normal diet remain symptom-free and serologically negative.
Area of Science:
- Pediatric gastroenterology
- Immunology
- Genetics
Background:
- The long-term outcome of potential celiac disease (CD) requires further investigation.
- Genetic predisposition plays a role in celiac disease development.
Purpose of the Study:
- To assess the 10-year progression of potential CD to overt CD in genetically predisposed children.
- Evaluate the long-term outcomes in children with potential celiac disease on a gluten-containing diet.
Main Methods:
- Prospective follow-up of 553 children with CD-predisposing HLA genes from birth (CELIPREV study).
- Children with potential CD received annual serological screening while maintaining a normal diet.
- Intestinal biopsy was performed for persistent positive serology.
Main Results:
- 26 children (4.7%) were diagnosed with potential CD, all asymptomatic.
- Over 10 years, only 3 (13%) progressed to overt CD.
- 19 children (83%) became antibody-negative within 1 year and remained so, with one showing fluctuating antibodies.
Conclusions:
- The risk of progression from potential CD to overt CD is very low in genetically predisposed children on a gluten-containing diet.
- Long-term monitoring suggests potential CD often resolves or remains quiescent in children without intervention.
Background:
The long-term outcome of potential celiac disease (CD) is still a debated issue. We aimed to evaluate the progression of potential CD versus overt CD after 10-years of follow-up in a cohort of children genetically predisposed to CD.
Methods:
The CELIPREV study is prospectively following from birth 553 children with CD-predisposing HLA genes. Children with a diagnosis of potential CD continued to receive a normal diet and repeated the serological screening for CD every year. An intestinal biopsy was taken in presence of persistent positive serology.
Results:
Overall, 26 (4.7%) children received a diagnosis of potential CD (50% females, median age 24 months). All children were symptom-free. Twenty-three children continued a gluten-containing diet; at 10 years from the first biopsy, three children developed overt CD (13%), 19 (83%) became antibodies negative at 1 year from the first biopsy and remained negative up to 10 years of follow-up and one subject (4%) had fluctuating antibody course with transiently negative values and persistently negative biopsy.
Conclusions:
In children genetically predisposed to CD with a diagnosis of potential CD the risk of progression to overt CD while on a gluten-containing diet is very low in the long-term.
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