Sa1279 Short-Term Progression of Histology in Indian Patients With Potential Celiac Disease

Abstract

Background: The widespread application of serological tests for celiac disease (CD) lead to the introduction of Potential Celiac Disease (PCD) as an entity with a normal duodenal histology along with a positive serological test. The progression of PCD to overt celiac disease has been described in some studies from the west in upto one third of patients over a period of 1 -3 years. There are no Asian data on this aspect of CD. We have evaluated the short term histological progression of PCD in Indian patients. Methods: Patients with PCD were prospectively identified by screening relatives of patients with celiac disease, diarrheal subtype of irritable bowel syndrome and patients with iron deficiency anemia. IgA anti-tissue transglutaminase antibody was determined by ELISA. Patients with positive serology were subjected to endoscopy with duodenal biopsy. Potential Celiac Disease was defined as Marsh 0-II lesion on duodenal biopsy along with positive IgA tTG serology. Patients with Marsh-III changes were excluded from the study. Retesting for serology and histology was done at 6-monthly intervals for 12 months in those with initial diagnosis of PCD. Results: 57 patients (23 males), mean age 28.7 years (range 473yrs) were diagnosed to have PCD. Duodenal biopsy showed Marsh-0/I/II changes in 28/27/2 patients, respectively. At 6 months, 12 patients became seronegative. The remaining 45 patients continued to be seropositive at 12 months. Histological progression to Marsh-III occurred in only 4 patients while progression from Marsh-0 to Marsh-I or Marsh II occurred in 6 and 1 patients, respectively. Fourteen patients with Marsh-I showed regression to Marsh-0. Of the two patients who were initially Marsh II, one remained so at follow up and one showed regression to Marsh 0 Conclusion: Histological progression to Marsh-III occurred in only 7% of patients with PCD. These observations do not justify starting gluten-free diet in all patients with PCD Bar diagram showing follow up histology at 6 and 12 months in 28 patients who were