Natural history of potential celiac disease in children

Clin Gastroenterol Hepatol. 2011 Apr;9(4):320-5; quiz e36. doi: 10.1016/j.cgh.2010.09.006. Epub 2010 Sep 17.


Background & aims: The presence of celiac disease-associated autoantibodies (antiendomysium and antitissue transglutaminase [anti-TG2]) with normal jejunal mucosa indicate potential celiac disease. We performed a prospective, 3-year cohort study to determine the natural history of potential celiac disease in children.

Methods: The study included 106 children with potential celiac disease, based on serology analysis and normal duodenal architecture. All but 2 carried the HLA-DQ2 and/or DQ8 haplotype. In all children, every 6 months, growth, nutritional parameters, celiac disease serology, and autoimmunity were investigated. In biopsies, γδ intraepithelial-, CD3-, and lamina propria CD25-positive cells were counted; duodenal deposits of anti-TG2 immunoglobulin A were detected. Biopsy analysis was repeated after 2 years on patients with persistent positive serology and/or symptoms.

Results: Celiac disease was detected primarily in first-degree relatives and patients with autoimmune disorders (40.6%). A gluten-free diet was prescribed to 20/106 patients because of symptoms, which were relieved in only 11. Eighty-nine of the 106 patients entered the follow-up study, with normal daily consumption of gluten. During the follow-up antibodies disappeared in 14.6% and fluctuated in 32.6%. Villous atrophy was observed in 12/39 patients (30.8%) who underwent a repeat biopsy.

Conclusions: Most children with potential celiac disease remain healthy. After 3 years, approximately 33% of patients develop villous atrophy. Intestinal deposits of anti-TG2 IgA identify children at risk for villous atrophy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Asymptomatic Diseases*
  • Autoantibodies / blood*
  • Biopsy
  • Celiac Disease / diagnosis
  • Celiac Disease / pathology*
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Intestinal Mucosa / pathology*
  • Jejunum / pathology*
  • Male
  • Prospective Studies


  • Autoantibodies