Diagnosis and follow-up of children with potential celiac disease on a gluten-containing diet

Background and objectives

Potential celiac disease (PCD) is defined as elevated celiac serology with a preserved small intestinal mucosa. This study aimed to identify baseline characteristics and the outcomes of children with PCD consuming a gluten-containing diet.

Methods

This was a retrospective cohort study of pediatric PCD patients diagnosed between 12/2018 and 10/2024. Baseline data included demographics, anthropometrics, clinical symptoms and signs, celiac serology, and biopsy results. Follow-up data included repeat serology and biopsy results when performed.

Results

PCD was diagnosed in 75/517 (14.5%) children undergoing upper endoscopy for suspected celiac disease (CeD). Baseline anti-transglutaminase IgA (TTG) was above 10× the upper limit of normal (ULN) in 18 (24%), between 3–10× ULN in 52 (69.3%), and <3× ULN in five (6.6%). Anti-endomysial antibody was positive in 57 (76%). Among 48 children (64%) with at least one year of follow-up, TTG normalized in 26 (54.1%), decreased to <3× ULN in 13 (27.1%), was between 3–10× ULN in six (12.5%), and was above 10× ULN in three (6.3%). Nine children had a repeat endoscopy, and six (66.7%) were diagnosed with CeD, while three remained PCD. Among the 11 children with TTG >10× ULN and at least one year of follow-up, TTG normalized in three, declined in five, and increased or remained above 10× ULN in three.

Conclusions

PCD is common and occurs in approximately 15% of children undergoing upper endoscopy for suspected CeD. It may occur in patients with serology levels above 10× ULN. Pediatric patients with PCD can and should be followed while consuming a GCD, given that the majority of patients will not progress to CeD. Approximately 50% of PCD patients will normalize TTG levels, and close to 30% will decrease levels to below 3× ULN. All PCD patients should have regular serological testing and clinical follow-up by a pediatric gastroenterologist, with the option of repeated biopsy when indicated. CeD may be overdiagnosed if endoscopy and biopsy are not performed at the time of diagnosis.

Full text

https://www.xiahepublishing.com/2994-8754/JTG-2025-00032

The study was recently published in the Journal of Translational Gastroenterology.

Journal of Translational Gastroenterology (JTG) dedicates to improving clinical diagnosis and treatment, advancing understanding of the molecular mechanisms, and promoting translation from bench to bedside of gastrointestinal, hepatobiliary, and pancreatic diseases. The aim of JTG is to provide a forum for the exchange of ideas and concepts on basic, translational, and clinical aspects of gastroenterology, and promote cross-disciplinary research and collaboration.

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