Comparable disease course in pediatric celiac disease with or without endoscopic confirmation at high anti-TG2-IgA-antibody titers

The guidelines from the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) enable the diagnosis of celiac disease (CD) omitting esophagogastroduodenoscopy (EGD) in patients with high anti-Transglutaminase 2 (TG2)-IgA-antibodies. However, there is uncertainty whether this approach is safe in terms of disease outcomes for all patients. Here, we aimed to investigate the course of anti-TG2-IgA-antibodies, symptomatic response, anthropometric measurements and routine laboratory values in CD patients presenting with high anti-TG2-IgA-antibodies diagnosed with or without EGD.

We conducted a retrospective case-control study in two pediatric gastroenterology centers in Giessen and Marburg. CD patients presenting with high anti-TG2-IgA-antibodies (≥10× upper limit of normal) were included. Data were obtained from the routine medical documentation sheet at 0, 0.5, 1 and 2 years after diagnosis.

48 patients (24 patients per group) were included. Both groups did not differ in sex or age distribution, symptom burden, comorbidities, weight and BMI z-scores or routine laboratory parameters at baseline. Decline of anti-TG2-IgA-antibodies was similar in both groups. Serological remission was achieved in 6% (without EGD) and 16% (with EGD) at 0.5 years and 26% and 41% at 1 year after diagnosis with no significant differences between the two groups. Symptom relief, weight and BMI z-scores as well as hemoglobin, ferritin and mean corpuscular volume did not differ depending on the mode of diagnosis.

Our data confirm that the biopsy-sparing diagnostic algorithm is associated with similar serological and clinical outcomes in pediatric CD patients. Thus, our findings support the further application and implementation of the "non-biopsy approach."