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More Than Three Years for Normalisation of Routine Laboratory Values after Gluten Withdrawal in Paediatric Coeliac
Ignacio Ventura1,2, Belén Rodriguez1, Sandra Suescum1
1Molecular and Mitochondrial Medicine Research Group, School of Medicine and Health Sciences, Universidad Católica de Valencia 'San Vicent Mártir', 46001 Valencia, Spain.
Insights
Subclinical nutritional and inflammatory markers like low iron and high calcium can aid in diagnosing pediatric celiac disease. Analytical values typically normalize within five years on a gluten-free diet.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Immunology
Background:
- Celiac disease diagnosis and follow-up in children can be challenging.
- Nutritional and inflammatory status assessment offers insights into early detection and disease management.
- Symptom normalization in pediatric celiac disease typically spans approximately one year.
Purpose of the Study:
- To evaluate clinical manifestations and the normalization of routine blood analytics in Spanish children diagnosed with celiac disease.
- To identify key subclinical markers for early celiac disease detection in pediatric populations.
- To assess the long-term impact of a gluten-free diet on biochemical parameters.
Main Methods:
- A retrospective case-control study involving 21 pediatric celiac patients and 20 healthy controls.
- Longitudinal follow-up of celiac patients for five years after initiating a gluten-free diet (GFD).
- Analysis of blood samples for nutritional markers (iron, calcium) and inflammatory markers (transaminases, white blood cells) at diagnosis and during follow-up.
Main Results:
- At diagnosis, celiac patients exhibited statistically significant subclinical increases in blood calcium, transaminases, and white blood cells, alongside decreased serum iron.
- Routine analytical values demonstrated normalization within a five-year period following adherence to a gluten-free diet.
- Despite a gluten-free diet, levels of iron, calcium, transaminases, and leukocytes remained subclinically altered even after three years.
Conclusions:
- A combination of subclinical blood markers (low iron, high calcium, elevated leukocytes, lymphocytes, and ALT) and low growth percentile can aid in detecting celiac disease in children.
- These parameters may assist in diagnosing celiac disease in asymptomatic pediatric patients.
- Persistent subclinical alterations in certain blood markers highlight the need for continued monitoring even after initiating a gluten-free diet.
Abstract:
The assessment of the nutritional and inflammatory status of paediatric patients with coeliac disease is an interesting approach to early diagnosis and functional follow-up. Most authors agree that the normalisation of symptoms takes about one year. The aim of the study was to evaluate the clinical manifestation and normalisation of routine analytics in Spanish children diagnosed with celiac disease.
Methods:
We performed a retrospective case-control study in Spanish paediatric patients, including 21 celiac patients and 20 healthy controls. The 21 patients selected in the case-control study were followed for 5 years after starting a gluten-free diet (GFD). All patients had type 3 villous atrophy according to the Marsh-Oberhuber classification. A total of 39 blood samples were taken before the start of the GFD, and 109 were taken after. Twenty control sera from healthy donors were used for comparison.
Results:
We found that patients had a subclinical but statistically significant increase in blood calcium, transaminases, and white blood cells, and a decrease in serum iron, at the time of diagnosis. Our study also shows that analytical values normalise within five years on a gluten-free diet.
Conclusions:
The use of a combination of subclinical changes, including low iron, high calcium, elevated leukocytes, lymphocytes, and ALT levels in blood samples, together with a low growth percentile, is pertinent in detecting coeliac disease. This set of parameters could help in the diagnosis of patients without clinical symptoms. We can also show that the levels of Fe, Ca, transaminases, and leucocytes remain subclinically altered after 3 years, despite the gluten-free diet.
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