Prevalence and Predictors of Persistent Celiac Disease Antibody Positivity During Follow-Up

Follow-up of patients with celiac disease includes assessment of symptoms and adherence to the gluten-free diet. Though the latter is assessed via dietitian interview, serologies are often measured as a marker of gluten avoidance. We aimed to identify demographic and clinical factors associated with continued seropositivity at least one year after diagnosis of celiac disease.

We conducted a retrospective cohort study of adult patients (≥ 18 years) seen at a celiac disease referral center during a 24-month period. We used univariate and multivariate analysis to identify which characteristics are associated with seropositivity at the time of follow-up.

Of 541 patients, 156 (28.8%) had at least one positive serology (tTG IgA, deamidated gliadin IgA, or deamidated gliadin IgG) at follow-up, with over 50% of patients having been diagnosed at least 10 years prior to their follow-up visit. Compared to patients with negative serologies at follow-up, patients with persistent positivity were more likely to have been diagnosed more recently (p < 0.001), have prior antibodies checked in the past 2 years (62% vs. 47%; p = 0.01), and have race listed as non-white or unknown (35% vs 23% p = 0.004). On multivariate analysis, duration of celiac disease at time of serologic testing (odds ratio [OR] diagnosed 10 or more years prior to serology compared to 12-23 months 0.24; 95% confidence interval [CI] 0.11-0.52) and race (OR other or unknown race compared to white 1.81; 95% CI 1.15-2.83) were associated with persistent positivity. Individuals with persistent positivity were more likely to have Marsh scores of 3a or greater at follow-up compared to those with negative antibodies on univariate and multivariate analysis.

Persistent tTG IgA or deamidated gliadin IgA/IgG positivity one year or longer after initial diagnosis is common, occurring in > 25% of patients. Persistently elevated antibodies were associated with decreased time since initial diagnosis and race. Using clinical and demographic factors, such as time since diagnosis, may help predict persistent seropositivity, which correlates with a higher likelihood of persistent villus atrophy.