Heterogeneous outcomes in pediatric potential celiac disease: A multicenter longitudinal study

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.