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What is the Best Strategy for Children with Celiac Disease?

Most children with potential celiac disease, based on serologic markers, remain healthy after 3 years—only about a third develop villous atrophy, report Antonella Tosco et al. in the April issue of Clinical Gastroenterology and Hepatology. However, antibody tests can identify children at greatest risk for the changes in the intestinal villi that are typically associated with celiac disease (villous atrophy).

Several tests are used to screen children for potential celiac disease—these include measurement and localization of intraepithelial lymphocytes and serologic tests for auto-antibodies. But what should be done when a child has a positive test result but no symptoms or villous atrophy?

Tosco et al. followed 106 children who had potential celiac disease based on serologic analysis for anti-endomysium and anti-tissue transglutaminase; none of the children had villous atrophy, based on analysis of biopsy samples.

Twenty children were placed on a gluten-free diet because they eventually developed symptoms, which were relieved in only 11. The other 86 children consumed normal, daily amounts of gluten. The auto-antibodies disappeared in 14.6% and levels fluctuated in 32.6%. After 2 years, 39 underwent a second biopsy analysis, and 31% were found to have developed villous atrophy.

In biopsy samples, transglutaminase deposits were a better predictor of which children would develop villous atrophy than other factors (see below figure). Transglutaminase deposits were present in the biopsy sample from 92% of the children who developed villous atrophy, compared with 59% who did not.

Antibody deposits (green) in duodenal mucosa from a patient with potential celiac disease, with subepithelial localization of transglutaminase (red).

In an accompanying editorial, Edward Hoffenberg and Edwin Liu warn that autoimmunity to antigens associated with celiac disease, even in patients with normal villous architecture, cannot be ignored. They state that it is premature to propose general changes to patient care without a good way to identify which subsets of seropositive patients will go on to develop villous atrophy, and which patients without symptoms will develop long-term complications.

More Information on Celiac Disease:

Read the article online. This article has accompanying CME.
Tosco A, Salvati VM, Auricchio T, et al. Natural history of potential celiac disease in children. Clin Gastroenterol and Hepatol 2011;9:320–325.

Read the accompanying editorial.
Hoffenberg EJ and Liu E. Screening-identified celiac disease: who needs treatment and when? Clin Gastroenterol and Hepatol 2011;9:284–285.

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Kristine Novak

Kristine Novak

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About The Author:

Dr. Kristine Novak

Dr. Kristine Novak

Dr. Kristine Novak is a science writer and editor based in San Francisco. She has extensive experience covering gastroenterology, hepatology, immunology, oncology, clinical, and biotechnology research discoveries.

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