Heterogeneous outcomes in pediatric potential celiac disease: A multicenter longitudinal study
Barak Laxer1, Firas Rinawi2,3, Nadya Ziv-Sokolovskaya4
1Pediatric Division, Kaplan Medical Center, Rehovot, Israel.
Insights
In children with potential celiac disease (PCD) on a gluten-containing diet (GCD), about one-fifth progress to celiac disease (CeD) over time. Many achieve normal antibody levels, showing varied outcomes that require monitoring.
Area of Science:
- Pediatric Gastroenterology
- Celiac Disease Research
- Immunology
Background:
- Potential celiac disease (PCD) is characterized by positive celiac serology without intestinal villous atrophy.
- Understanding the natural history of PCD in children on a gluten-containing diet (GCD) is crucial for management.
- Previous studies have not fully elucidated the long-term outcomes of pediatric PCD.
Purpose of the Study:
- To investigate the clinical and serological outcomes of children diagnosed with PCD.
- To determine the rate of progression from PCD to celiac disease (CeD) in pediatric patients on a GCD.
- To identify factors influencing PCD outcomes, including serological normalization and disease progression.
Main Methods:
- A longitudinal cohort study of 88 children diagnosed with PCD across three pediatric gastroenterology centers.
- Patients were followed for a minimum of 12 months (mean 39 months) on a GCD, with data collection until October 2024.
- Baseline and follow-up assessments included demographics, celiac serology (anti-tissue transglutaminase antibodies - tTG), and histological findings when available.
Main Results:
- Of 88 children with PCD, 17 (19.5%) progressed to CeD during the follow-up period.
- Serological normalization (tTG) while continuing GCD occurred in 33 (37.5%) patients.
- Asymptomatic patients showed higher rates of tTG normalization (61.9% vs. 35.8%). Baseline tTG levels and Marsh 1 histology did not significantly predict outcomes.
Conclusions:
- Approximately one-fifth of children with PCD on a GCD progress to CeD within a mean follow-up of 3.3 years.
- Baseline serological markers are not reliable predictors of future mucosal changes or disease progression.
- A significant proportion of children with PCD can achieve serological normalization on a GCD, highlighting the heterogeneous nature of the condition and the need for ongoing monitoring.
Objectives:
Potential celiac disease (PCD) is defined by positive celiac serology without villous atrophy. We aimed to study the outcome of children with PCD consuming a gluten-containing diet (GCD) over time.
Methods:
Children diagnosed with PCD between December 2018 and January 2022, in three pediatric gastroenterology centers, were longitudinally followed. Data were collected until October 2024, with a minimum follow-up of 12 months, unless celiac disease (CeD) was diagnosed earlier. Baseline data included demographics, celiac serology, and histological findings. Follow-up data included serology and biopsy results when performed.
Results:
The cohort included 88 patients with PCD, with a mean follow-up of 39 (range 12- 69) months. During this period, 17 (19.5%) patients progressed to CeD. Normalization of anti-tissue transglutaminase antibodies (tTG), while continuing a GCD, occurred in 33/88 (37.5%) while the rest remained with PCD. Specifically, among 16 patients with tTG levels >×10 upper limit of normal (ULN) at PCD diagnosis, three (18.8%) progressed to CeD, six (37.5%) normalized tTG while continued GCD, and the rest remained unchanged. Asymptomatic patients had higher rates of tTG normalization (61.9% vs. 35.8%, p = 0.0011). Neither tTG levels, nor having Marsh 1 histology, had a significant effect on PCD outcomes.
Conclusions:
Among pediatric patients with PCD, during a mean follow-up of 3.3 years, one-fifth progressed to CeD. Baseline serology levels do not reliably predict future mucosal deterioration. Over a third of children with PCD may achieve serological normalization while maintaining a GCD. This heterogeneous pattern of PCD warrants periodic serological and histological follow-up.
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