Medicina (Kaunas). 2023 Jun 21;59(7):1182. doi: 10.3390/medicina59071182.

Michal Kori ^1 2, Chani Topf-Olivestone ³, Firas Rinawi ^4 5, Raffi Lev-Tzion ⁶, Nadya Ziv-Sokolovskaya ⁷, Noy Lapidot Alon ^8 9, Anat Guz-Mark ^8 9, Raanan Shamir ^8 9

Author information

¹Pediatric Gastroenterology, Kaplan Medical Center, Rehovot 5801303, Israel.

²Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel.

³Pediatric Gastroenterology, Assuta Medical Center, Ashdod 7747629, Israel.

⁴Pediatric Gastroenterology, Emek Medical Center, Afula 1834111, Israel.

⁵The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa 3200001, Israel.

⁶Juliet Keidan Institute of Pediatric Gastroenterology, Shaare Zedek Medical Center, Jerusalem 9103102, Israel.

⁷Institute of Pathology, Kaplan Medical Center, Rehovot 5801303, Israel.

⁸Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel.

⁹Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel.

Abstract

Background and Objectives: Potential Celiac Disease (PCD) is defined by positive celiac serology without villous atrophy. We aimed to describe the short-term outcome of pediatric PCD while consuming a gluten-containing diet (GCD). Materials and Methods: Retrospective analysis of pediatric PCD patients continuing GCD, between December 2018-January 2022. Baseline demographics, celiac serology and duodenal biopsy results were reviewed. Follow-up data included repeated serology and biopsy results when performed. Minimum follow-up was 12 months unless celiac disease (CeD) was diagnosed earlier. Results: PCD was diagnosed in 90 children (71% females) with a mean age of 7.2 (range 1.8-16.5) years. Baseline anti-tissue transglutaminase (TTG) levels were above 10 times the upper limit of normal (ULN) in 17/90 (18.9%), 3-10 × ULN in 56/90 (62.2%) and 1-3 × ULN in 17/90 (18.9%). During follow-up, the mean time was 17.6 (range 5-35) months, TTG normalized in 34/90 (37.8%), was stable in 48/90 (53.3%), and increased or remained >10 × ULN in 8/90 (8.9%). In 20/90 (22.2%) patients, a repeat endoscopy was performed, leading to CeD diagnosis in 12/20 (60%). Thus, at the end of follow-up, CeD was diagnosed in 12/90 (13.3%). In patients with TTG >10 × ULN at diagnosis, TTG normalized in 5/17, decreased to 3-10 × ULN in 8/17, and remained above 10 × ULN in 4/17. Conclusions: During the short-term follow-up of pediatric PCD patients, less than 15% progressed to CeD. A third had normalized TTG levels, including children with TTG >10 × ULN, indicating the need for periodic serological and histological follow-up among PCD patients.