Dig Liver Dis. 2022 Mar;54(3):336-342.

doi: 10.1016/j.dld.2021.06.026. Epub 2021 Jul 14.

Francesca Sbravati ¹, Anita Cosentino ², Jacopo Lenzi ³, Michelangelo Fiorentino ⁴, Francesca Ambrosi ⁵, Angela Salerno ⁶, Annarita Di Biase ⁷, Beatrice Righi ⁶, Sandra Brusa ⁷, Paola Sogno Valin ⁷, Laura Bruni ², Barbara Battistini ⁷, Sara Pagano ¹, Ana Gabriela Grondona ⁸, Flavio Labriola ¹, Patrizia Alvisi ⁹

Author information

¹Pediatric Gastroenterology Unit, Department of Pediatrics, Maggiore Hospital, Largo B. Nigrisoli 2, Bologna 40132, Italy.

²Specialty School of Pediatrics-Alma Mater Studiorum, Università di Bologna, Italy.

³Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna 40138, Italy.

⁴Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Bologna 40138, Italy.

⁵Bologna Metropolitan Department of Pathology, Maggiore Hospital, Bologna 40132, Italy.

⁶Department of Pediatrics, University of Modena, Modena 41125, Italy.

⁷Pediatric Unit, Santa Maria della Scaletta Hospital, Imola 40026, Italy.

⁸Unified Metropolitan Laboratory, Autoimmunity and Allergy, Maggiore Hospital, Bologna 40132, Italy.

⁹Pediatric Gastroenterology Unit, Department of Pediatrics, Maggiore Hospital, Largo B. Nigrisoli 2, Bologna 40132, Italy. Electronic address: patrizia.alvisi@ausl.bologna.it.

Abstract

Introduction: Few data are available regarding the trend of IgA anti-transglutaminase antibodies (TGA-IgA) in children with celiac disease (CD) on a gluten-free diet (GFD). Our aim is to examine the normalization time of CD serology in a large pediatric population, and its predictors.

Material and methods: We retrospectively evaluated the normalization time of TGA-IgA and its predictive factors (age, sex, ethnicity, symptoms, associated diabetes/thyroiditis, Marsh stage, TGA-IgA and endomysial antibody levels at diagnosis, diet adherence), in 1024 children diagnosed from 2000 to 2019 in three pediatric Italian centers, on a GFD.

Results: TGA-IgA remission was reached in 67,3%, 80,7%, 89,8% and 94,9% after 12, 18, 24 and 36 months from starting a GFD, respectively (median time = 9 months). TGA-IgA >10´upper limit of normal at diagnosis (HR = 0.56), age 7-12 years old (HR = 0.83), poor compliance to diet (HR = 0.69), female sex (HR = 0.82), non-Caucasian ethnicity (HR = 0.75), and comorbidities (HR = 0.72) were independent factors significantly associated with longer time to normalization.

Conclusions: Our population is the largest in the literature, with the majority of patients normalizing CD serology within 24 months from starting a GFD. We suggest a special attention to patients with comorbidities, language barriers or age 7-12 years for a proper management and follow-up.