Increased parotid microvascularity without stiffness differences in children with celiac disease

Celiac disease is a systemic autoimmune disorder that can affect salivary glands, yet subclinical involvement in children is under-investigated. Conventional ultrasound often lacks sensitivity for detecting early inflammatory or subtle microvascular changes in asymptomatic patients.

We aimed to evaluate subclinical parotid gland involvement in children with celiac disease using microvascular imaging and shear wave elastography (SWE), hypothesizing that these tools could detect early parenchymal and microcirculatory alterations.

This prospective, cross-sectional case-control study included 78 children with biopsy-confirmed celiac disease and 72 age- and body mass index-matched healthy controls. Bilateral parotid microvascularity index (MVI, %) and tissue stiffness (SWE, kPa) were assessed using high-resolution ultrasonography by an experienced radiologist who was blinded to the group allocation and clinical data. Between-group comparisons were performed using two-sided Mann-Whitney U tests. Within the celiac disease group, imaging metrics were explored according to gluten-free diet duration, serum tissue transglutaminase IgA (tTG-IgA) levels, and modified Marsh grade.

The MVI was higher in the celiac disease group for both the left (median [interquartile range], 5.29 [3.12-10.80] vs 2.00 [1.03-4.78]; P<0.001) and right (4.55 [2.42-10.82] vs 3.25 [0.90-5.48]; P=0.001) parotid glands. However, SWE did not differ significantly between groups (left P=0.21; right P=0.09). Within the celiac disease group, imaging metrics were not significantly associated with tTG-IgA levels or Marsh subtypes (all P>0.05).

Pediatric celiac disease is associated with increased parotid microvascularity without detectable stiffness differences, suggesting subclinical microvascular alterations. These exploratory findings warrant longitudinal validation to clarify temporal dynamics and clinical relevance.