Journal of pediatric gastroenterology and nutrition · 2026
Heterogeneous outcomes in pediatric potential celiac disease: A multicenter longitudinal study.
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Laxer Barak, Rinawi Firas, Ziv-Sokolovskaya Nadya, Shamir Raanan, Kori Michal, Guz-Mark Anat
Аннотация
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.
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.