The rate of relapse after the gluten challenge in patients suspected to have celiac disease: Are there any age differences?

Abstract

Celiac disease (CD) is a permanent intestinal intolerance to dietary wheat ghadin and related proteins that produce mucosal lesior~ in genetically susceptible indi~'iduals and is treated with fikdong gluteudree diet. It is suggested that CD in children bellow two years of age should be diagnosed tbfiowing fhe old ESPGAN criteria (diagnosis is based on findings of 3 small intestinal biopsies) while in those older than two years revised ESPGAN criteria (Just one small intestinal biopsy and a good clinical response on a gluten&ee die0 is sulBcietu, fhe aim of the study was to determine whether the incidence of patients whose diagnosis of CD was not contirrtmd by the third biopsy was influenced by patients age at the time of the hrst biopsy (when the diagnose was suspected). Patients and methods: In order to diagnose CD in 62 patients, irrespective of their age, the old ESPGAN criteria with at least three small intestinal biopsies were applied. According to the age at the time of the first biopsy patients were divided in two groups: Group A: those younger than 24 months (N = 49) and Group B: those older than 24 months (N = 13). Suction small intestinal biopsies were perlormed m the regiou of Treitz, and all biopsy samples were analysed by the same pathologist. Student T test was used to evaluate the difterences between the age groups. Resuhs: After 6 months of gluten challenge 13 patients in Group A (13/49 = 26,5~ had normal small intesnnal biopsy findings. Moreover, 7 of them (7/49 = i4%) are followed tot more than two years on uormal gluten containing diet and still do not have a histological relapse, in Group B (N = 13) 5 patients (38.5%) had a normal biopsy finding alter 6 months gluten challenge, and 3 of them (23%) are on a gluten containing diet for more than two ),ears, still without the histological relapse. Although the proportion of patients who did not have the histological relapse was higher in Group B, the difli:rence was not statistically significant after 6 months (p>0.05) nor after 24 months of gluten challenge (p>0.05). Conclusion: A high proportion of patients, irrespective of their age, did not have the histological relapse alter more than two years of gluten containing diet These results show that different diagusuc criteria tor patients younger and older than two years may be implausible.