Clinical Manifestations Of Celiac Disease Research Articles

Beyond diagnosis: exploring coeliac disease incidence alongside clinical and laboratory characteristics of newly diagnosed children in Slovenia.

Coeliac disease is characterized by a wide array of clinical presentations. The focus of our study was to comprehensively assess the clinical manifestations of coeliac disease in newly diagnosed children in Slovenia. Our objectives include estimating the incidence of the disease in children in 2022. In this prospective study, Slovenian paediatric gastroenterologists were invited to provide patient data using medical records of children under 19 diagnosed with coeliac disease from March 2021 to October 2023. Patient data were collected through a dedicated web-based form adapted from the CD SKILLS project, including data on clinical manifestations and laboratory results. Furthermore, the study included an estimation of the incidence of coeliac disease in children and adolescents in Slovenia in 2022. Analysis involved data from 160 children and adolescents (median age: 8 years; 61.9% female). Overall, 16.9% were asymptomatic at diagnosis and 29.4% belonged to a high-risk group for coeliac disease. Among symptomatic cases (N = 133), abdominal pain was the leading symptom (44.4%), followed by anaemia (12.0%) and diarrhoea (10.5%). Malabsorption symptoms were more prevalent in very young children. Anaemia was found in 22.8 and 10.7% had abnormal alanine aminotransferase levels. The estimated incidence of coeliac disease in Slovene children in 2022 was 17.5/100 000. Abdominal pain emerged as the primary symptom of coeliac disease in children and adolescents, except in very young children where malabsorption symptoms were predominant. Our observation of a lower prevalence of abnormal liver function tests suggests subclinical coeliac disease may be less common in children. Moreover, the calculated coeliac disease incidence in Slovenia aligns with existing data.

Bone fractures in children with celiac disease: analysis of clinical and anthropometric measurements and bone metabolism markers

Introduction. Abnormal bone remodelling process is one of the clinical manifestations of celiac disease, which increases the risk of developing osteopenia conditions, including bone fractures. The median age for the first fracture is similar in celiac disease and in the general population, but the incidence is higher in patients with celiac disease.Aim. To compare clinical and anamnestic characteristics, anthropometric measurements and laboratory test results in celiac children and adolescents with and without bone fractures.Materials and methods. A total of 151 children aged 1-17 years were included in the study. Patients were divided into two groups: those who had fractures in their lifetime - 21 (13.9%) children and those who had no fractures - 130 (86.1%) children. Results. The frequency of fractures among the patients included in the study was 13.9%, while among children with vitamin D deficiency fractures were reported 2.7 times more often than among children with its optimal level (p = 0.019).Vitamin D deficiency was detected in 20 (95.2%) children with fractures, and levels of 30 ng/ml or higher were found in 1 (4.8%) child. In the group of patients without fractures, the 25(OH)D optimal level was observed in 43 (33.1%) cases.It was found that patients with fractures had a significantly lower osteocalcin level than children without fractures - 26.9 (15.6; 32.9) ng/ml (p < 0.001), and children with fractures had C-terminal telopeptide level 1.9 times higher than the group of children without fractures (p = 0.01). The median PTH concentration in children with fractures was 34.6 (19.6; 54.7) pg/ml, whereas in children without fractures it was 24.2 (17.1; 39.5) pg/ml (p = 0.1).Conclusion. Due to elevated PTH level and severe vitamin D deficiency, a predominance of osteoresorption over osteosynthesis was observed in children with celiac disease and fractures of tubular bones. It is important to maintain a 25(OH)D optimal level and monitor biochemical markers of bone metabolism in patients with celiac disease to assess the processes of bone formation and resorption.

Knowledge regarding celiac disease among healthcare professionals, patients and their caregivers in Turkey.

Celiac disease (CD) is one of the most prevalent chronic disorders. The clinical manifestations of CD are diverse and may present with gastrointestinal findings, extra-intestinal findings or no symptoms. Although there has been a marked increase in the prevalence of CD in the past 30 years, up to 95% of patients with CD remain undiagnosed. As most cases have atypical signs or no symptoms, the diagnosis of CD is either missed or delayed. In addition, one of the most important reasons for the delay in diagnosis may be the poor knowledge of healthcare professionals (HCPs) regarding CD. To evaluate the knowledge of HCPs, patients and their caregivers (parents) regarding CD. The current study was carried out between June 2021 and February 2022 prospectively, as part of the Focus IN CD project. Patients with CD and their caregivers participated in the study from 6 different cities in Turkey. General practitioners, pediatricians, pediatricians with other subspecialities and pediatric gastroenterologists from different cities participated in the study. The questionnaire was completed by 348 HCPs, 34 patients with CD, and 102 mothers and 34 fathers of patients with CD. Most of the participants were general practitioners (37.07%). There were 89 (25.57%) pediatricians and 72 (20.69%) pediatric gastroenterologists in the study. The highest score in all categories was achieved by pediatric gastroenterologists. There were significant differences between the four groups of HCPs in terms of the subsections of overall mean score, epidemiology and clinical presentation, treatment and follow-up. No significant difference was found between the groups (patients with CD, mothers of patients with CD and fathers of patients with CD) in terms of the questionnaire subsections. The level of knowledge on CD among HCPs, patients and their caregivers was unsatisfactory. We consider that it is necessary to increase awareness and to develop e-learning activities on CD among HCPs, patients and their caregivers. Consequently, they may benefit from e-learning programs similar to the one created as part of the EU-funded project Focus IN CD (https://www.celiacfacts.eu/focusincd-en).

Buzdağının görünmeyen yüzü: Ekstraintestinal Bulgular ve Çölyak Hastalığı

Aim: Clinical manifestations of celiac disease (CD) can be quite different and varying. The number of CDs presenting with atypical symptoms is increasing day by day. Hence, we aimed to determine how many patients with CD were atypical celiac through examining their admission complaints, clinical characteristics, laboratory results, endoscopic findings, and pathological findings. 
 Material and Methods: Eighty-nine patients with CD aged over 18 years who were followed-up in Ankara Kecioren Training and Research Hospital Internal Medicine Clinic between 2007 and 2014 were included in the study. The files of the patients were reviewed retrospectively. Sex, age, hospital admission complaints, clinical characteristics, laboratory results, endoscopy findings, and pathology results of the patients were recorded.
 Results: The median age of the patients in the study was 36, and 68.5% of them were female. The most common symptoms of the patients were fatigue (49.4%), anorexia (33.7%), and dyspepsia (22.5%), while diarrhea (19.1%), which is among the classical symptoms, was less common. 7.8% of the patients had no complaints at the time of admission, whereas 47.1% of them had only extraintestinal symptoms. At admission, 47% of the patients had anemia, 73.4% had iron deficiency, and 55.4% of them had vitamin B12 deficiency. When hemoglobin, ferritin, and vitamin B12 levels were compared before and after a gluten-free diet, a significant increase was determined. Transaminase elevation was detected in 25.3% of our patients at the time of diagnosis. When pre-treatment and post-treatment values were compared, a significant decrease was determined in those with high transaminase levels. In the pre-treatment serological test results of the patients, Ig A EMA positivity was the most common finding with a rate of 90.2%, followed by IgG EMA with 88.9%. In terms of pre-treatment endoscopy findings, 50.2% of our patients had normal appearance, 25.4% had a mosaic pattern, 12.6% had effacement of the duodenal folds, 12.6% had a nodular appearance, and 9.5% had a scalloping of the duodenal folds. When the pathology results of our patients were examined, 83.4% of them were at the advanced stage and with Marsh Type 3. 
 Conclusion: CD may present with atypical complaints such as extraintestinal findings, as in more than half of the patients in this study. Celiac disease should be taken into consideration, particularly in conditions such as iron deficiency, osteoporosis, and transaminase elevations, which are prevalent in the community. The prevalence of CD in our country is estimated to be around 1-2%; however, it is considered that there are more asymptomatic patients with atypical celiac disease. When diagnosing CD, the most crucial step is to consider the potential presence of CD during pre-diagnoses. Thus, CD should be included in the differential diagnosis, specifically in patients presenting with atypical symptoms.

More Than Celiac Disease - Five Gluten-induced Pathologies

Gluten can induce several conditions. However, a lot of people and even medical practitioners only associate gluten pathology with its most severe form neglecting other pathologies. In addition to this, clinical manifestations of celiac disease are not always classic and for this reason, many cases are diagnosed late, being characterized by intricate symptoms that can be attributed to other conditions. In the present study, we try to bring a systematization of the five major gluten-induced manifestations: celiac disease, non-celiac gluten sensitivity, wheat allergy, gluten ataxia, and dermatitis herpetiformis.

Celiac Disease Prevalence in Patients with Chronic Noninflammatory Diarrhea in 2017

Introduction: Celiac disease is an autoimmune disorder. Eating gluten, which is part of the cereals, can lead to intestinal mucosal injury and diarrhea. Although celiac disease is more common today with non-digestive symptoms, we sometimes encounter cases of chronic non-inflammatory diarrhea, which is one of the clinical manifestations of celiac disease. This study was performed to evaluate the prevalence of celiac disease in patients with chronic non-inflammatory diarrhea. Because diarrhea in celiac disease has distinct and efficient treatment we decided to do this study to evaluate the prevalence of celiac disease in patients with chronic non-inflammatory diarrhea.
 Methods: This was a descriptive cross sectional study on 200 patients with chronic non-inflammatory diarrhea in Yazd in 2017. Stool exam and tissue transglutaminase Antibody (TTG Ab) was done for the patients; upper endoscopy and duodenum biopsy was done for the patients with high serum TTG Ab. Findings analyzed in SPSS.ver.17 statistical software. Chi-Square, t-test and Fisher Exact tests were used for statistical analysis. P-value less than 0.05 was considered significant.
 Results: Two hundred patients, including 93 (46.5%) men and 107 women (53.5%) participated in this study. The average age was 34.32 ± 17.84 years. Among these cases, 31 patients (15.5%) had celiac disease. Among cases of celiac (16.1%), 15 (16.1%) were male and 16 (15%) were female. The relative frequency of celiac disease was the same in both sexes and in all age groups.
 Conclusion: Significant portion of patients (15.5%) with chronic non-inflammatory diarrhea has celiac disease.

Показатели физического развития детей с целиакией

Актуальность. Учитывая клинический полиморфизм целиакии, заболевание нередко в течение нескольких лет остается недиагностированным, что приводит к развитию серьезных изменений нутритивного статуса и задержки роста. Цель исследования: оценить физическое развитие детей и подростков на основании комплексного анализа антропометрических показателей в периоде клинической манифестации целиакии. Материалы и методы. Проанализированы результаты обследования 59 детей и подростков в возрасте от 6 месяцев до 18 лет с верифицированным диагнозом «целиакия». Антропометрические измерения проводились утром по общепринятым методикам. Данные антропометрических измерений детей оценивались по региональным стандартам. Рассчитывалось отклонение показателя длины тела относительно возраста (SDS длины тела), массы тела относительно длины тела (SDS массы тела). Статистическая обработка включала подсчет среднего арифметического значения каждого из показателей (М), среднего квад­ратичного отклонения (s), средней ошибки среднеарифметической (m), достоверности различий средних величин по t-критерию Стьюдента (р < 0,05). Результаты. Показатели физического развития детей с целиакией существенно отличались в зависимости от возраста верификации диагноза и продолжительности латентного периода заболевания. В структуре клинических проявлений у больных в остром периоде целиакии на первом месте находится задержка физического развития — 84,7 % человек. При этом в 76,3 % детей зарегистрирован дефицит массы тела: I степени — у 71,1%, II степени — у 22,2% и III степени — у 6,7 % случаев. Задержка роста установлена у 52,35 % детей: соматогенный нанизм обнаружен у 10,1 % больных, а низкорослость — у 42,3 % детей. Оценка стадии атрофии в соответствии с классификацией Marsh-Oberhuber показала, что у детей с более выраженной формой дефицита массы тела диагностирован тип Marsh 3C, тогда как при незначительном отставании показателей массы тела диагностированы типы Marsh 3A и Marsh 3В. Выводы. Антропометрические показатели пациентов с целиакией находятся в обратной зависимости от длительности латентного периода и возраста диагностики заболевания. У детей раннего возраста дефицит массы тела преобладает над задержкой роста, тогда как у старших детей отмечается замедление темпов роста с формированием низкорослости и соматогенного нанизма.

Clinical manifestations of celiac disease: towards early diagnosis

Celiac disease is characterized by significant clinical polymorphism, which makes it difficult to diagnose and postpones the start of pathogenetic treatment, ultimately worsening the prognosis of the disease. In this regard, knowledge of the clinical features and variants of the disease is of paramount importance for an effective diagnostic process. The article discusses various options for the clinical manifestations of celiac disease. The possibility of celiac disease should be borne in mind in patients with: 1. a history and clinical manifestations characteristic of celiac disease; 2. symptoms of celiac disease associated diseases; 3. symptoms that may be a manifestation of atypical celiac disease. Relatives of celiac patients are also at risk. Overweight and constipation do not reject the diagnosis of celiac disease. Taking into account all these circumstances will make it possible to diagnose and begin treatment in a timely manner, reasonably counting on its maximum effectiveness

Clinical and Paraclinical Screening for Celiac Disease in Children with Intractable Epilepsy.

Background Celiac disease is the inflammatory entropy caused by hypersensitivity to gluten, which occurs in susceptible individuals. Some studies have suggested a link between celiac disease and epilepsy in children. Our aim was to screen for clinical and paraclinical features of celiac disease in children with intractable epilepsy. Methods This was a cross-sectional study. Children aged 2 to 18 years with refractory epilepsy that referred to the pediatric neurology clinic within one year (2018–2019) were enrolled. Demographic and clinical characteristics of patients, especially clinical manifestations of celiac disease, were recorded in a questionnaire. A venous blood sample was sent to determine the total IgA, anti-tTG (IgA), and anti-endomysial antibody (IgA). Endoscopy was performed in cases where the celiac serological test was positive. Results Seventy children with idiopathic drug-resistant epilepsy (44 boys) were evaluated. The height-for-age index was 49.2% and the weight-for-age index was 38.2% less than normal. Constipation (48.6%), anorexia (25.7%), and abdominal pain (21.4%) were the most common gastrointestinal symptoms. Celiac serological tests were negative in all children. Therefore, endoscopy and bowel biopsy were not performed in any case. Conclusion Celiac disease was not found in any patient with intractable epilepsy. Gastrointestinal symptoms and growth disorders in this group may be related to the underlying disease or medications and not to celiac disease.

Relationship between duodenal microbiota composition, clinical features at diagnosis, and persistent symptoms in adult Coeliac disease

BackgroundDuodenal dysbiosis has been suggested to possibly influence the clinical manifestations of coeliac disease (CD), both at onset and when symptoms persist despite a gluten-free diet (GFD). AIMSTo evaluate the relationship between duodenal microbiota composition and: i) clinical phenotype of untreated CD (UCD); ii) presence and type of persistent symptoms despite a satisfactory serological and histological response to a strict GFD. MethodsDuodenal microbiota was analyzed by 16S rRNA sequencing and compared with i) clinical features in 12 adult UCD patients; ii) presence/absence and type of persistent symptoms (diarrhea-predominant vs. non-diarrhea predominant) in 25 adult treated coeliac patients (TCD) on a strict GFD. ResultsUCD with iron deficiency anemia (IDA) had a pro-inflammatory shift in their duodenal microbiota (reduction of Firmicutes, p = 0.03; increase of beta-Proteobacteria, p = 0.02) than those without IDA. TCD with persistent diarrhea showed a reduction of Actinobacteria (p = 0.03) and Rothia spp (p = 0.046) compared to TCD suffering from other type of persistent symptoms. ConclusionA distinctive duodenal microbiota profile is associated with IDA in UCD, and diarrhea-predominant persistent symptoms in TCD. Clinical interventions may include reconsidering patients presenting with IDA as a specific disease subtype, and dietary rebalancing if diarrhea persists despite histological response to a GFD.

Modern methods for estimation of dietary adherence and quality of life for patients with coeliac disease

Rationale: Coeliac disease (CD) impacts health-related quality of life (QOL) due to the requirement to follow a strict lifelong gluten free diet, a number of nutritional deficiencies and clinical manifestations of CD. The aim of our study is to monitor the dietary adherence and to estimate QOL in patients with CD using translated questionnaires.

Spontaneous jejunoileal perforation as a manifestation of celiac disease—a rare entity: a case report

Abstract Celiac disease or gluten-sensitive enteropathy is characterized by an autoimmune response in the small intestine triggered by the ingestion of gluten in the diet. It has a prevalence of 0.62% worldwide with considerable variation in incidence among countries. The clinical manifestations of celiac disease differ according to type: the classical type presents with intestinal symptoms, the non-classical type with intestinal or extraintestinal symptoms and the silent type is asymptomatic. Human leukocyte antigens (HLA)-DQ2 (DQA1_05/DQB1_02) are expressed in >90% of patients with celiac disease, and the presence of HLA-DQ2 or HLA-DQ8 (DQA1_ 0301/DQB1_0302) is necessary for its development. One complication of this disease is ulcerative jejunoileitis, a rare condition characterized by chronic idiopathic ulceration affecting the small intestine that can cause intestinal perforation resulting in high morbidity.

The Possible Role of Pathogenic and Non-Pathogenic Bacteria in Initiation and Exacerbation of Celiac Disease; A Comprehensive Review.

Celiac Disease (CD) is an immune-mediated enteropathy, generally of the proximal intestine, that occurs in genetically susceptible individuals triggered by the ingestion of gluten. The incidence and frequency of CD are increasing, and it is predicted that CD affects approximately 1% of the people worldwide. The common clinical manifestations of CD are divided in two sections, including classic and non-classic symptoms that can be created in childhood and adulthood. The relationship between pathogenic and non-pathogenic bacteria with CD is complex and multidirectional. In previous published studies, results demonstrated the triggering impact of bacteria, viruses, and parasites on initiation and development of Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS). Different studies revealed the inducing effect of pathogenic and non-pathogenic bacteria on CD. However, increasing evidence proposes that some of these microorganisms can also play several positive roles in CD process. Although information of the pathogenesis of the CD is quickly expanding, the possible role of bacteria needs further examination. In conclusion, with respect to the possible correlation between different bacteria in CD, the current review-based study aims to discuss the possible relationship between CD and pathogenic and non-pathogenic bacteria and to show various and significant aspects of mechanisms involved in the CD process.

Clinical Manifestations of Celiac Disease in Children with Type 1 Diabetes Mellitus- An Institutional Experience from Southern India

Clinical Manifestations of Celiac Disease in Children with Type 1 Diabetes Mellitus- An Institutional Experience from Southern India

Symptoms Prompting Interest in Celiac Disease and the Gluten-Free Diet: Analysis of Internet Search Term Data.

BackgroundCeliac disease, a common immune-based disease triggered by gluten, has diverse clinical manifestations, and the relative distribution of symptoms leading to diagnosis has not been well characterized in the population.ObjectiveThis study aimed to use search engine data to identify a set of symptoms and conditions that would identify individuals at elevated likelihood of a subsequent celiac disease diagnosis. We also measured the relative prominence of these search terms before versus after a search related to celiac disease.MethodsWe extracted English-language queries submitted to the Bing search engine in the United States and identified those who submitted a new celiac-related query during a 1-month period, without any celiac-related queries in the preceding 9 months. We compared the ratio between the number of times that each symptom or condition was asked in the 14 days preceding the first celiac-related query of each person and the number of searches for that same symptom or condition in the 14 days after the celiac-related query.ResultsWe identified 90,142 users who made a celiac-related query, of whom 6528 (7%) exhibited sustained interest, defined as making a query on more than 1 day. Though a variety of symptoms and associated conditions were also queried before a celiac-related query, the maximum area under the receiver operating characteristic curve was 0.53. The symptom most likely to be queried more before than after a celiac-related query was diarrhea (query ratio [QR] 1.28). Extraintestinal symptoms queried before a celiac disease query included headache (QR 1.26), anxiety (QR 1.10), depression (QR 1.03), and attention-deficit hyperactivity disorder (QR 1.64).ConclusionsWe found an increase in antecedent searches for symptoms known to be associated with celiac disease, a rise in searches for depression and anxiety, and an increase in symptoms that are associated with celiac disease but may not be reported to health care providers. The protean clinical manifestations of celiac disease are reflected in the diffuse nature of antecedent internet queries of those interested in celiac disease, underscoring the challenge of effective case-finding strategies.

Diagnosis of gluten-related enteropathy in a newborn: how and when?

To analyze the development of gliadin-specific immune responses in children with a genetic risk for CD and to determine whether these could be detected before the clinical onset of the disease by using immunological tests. Clinical manifestations of celiac disease (CD) in the first year of life is uncommon, which is due to the suboptimal sensitivity of tissue transglutaminase IgA antibodies (tTG-IgA) at this age and other possible causes of malabsorption in infants. The development of Deamidate gliadin peptide-specific antibodies (in particular DGP-IgG) in young children was poorly considered in the CD diagnosis. We conducted a retrospective cross-sectional study on children between one month and forty-eight months of life, which performed in our health center from 2016 to 2018. Three hundred and fifty children were selected according to strict inclusion criteria: positive for HLA-DQA1 and DQB1 alleles, positive anti tTG-IgA/IgG and/or positive DGP-IgG/IgA. Eighty-two children were selected and divided into two different groups of patients: Group one (forty newborns under twenty-four months of life) and Group two (children from twenty-five months to 48 months of life). Anti-DGP-IgG antibodies precede anti tTG-IgA seroconversion in children under two years in 80% of cases. Anti-DGP-IgG positive patients had milder symptomatic forms of CD than anti tTG-IgA positive children, characterized by gastrointestinal symptoms in the presence of normal growth, normal serum iron, and low MCH level. At tTG-IgA seroconversion, children present gastrointestinal clinical forms associated with impaired growth. The combined use of tTG-IgA and DGP-IgG antibodies upgrade the diagnostic sensitivity from 50% to 92%. Anti-DGP-IgG antibodies precede tTG-IgA seroconversion in newborns and identified two distinct clinical phenotypes. At this point, if you wanted to test your newborn patients for CD serology, how would you proceed?

Clinical Spectrum of Celiac Disease in Children in Sistan and Baluchestan Province.

The clinical manifestations of celiac disease (CD) have changed in the past decades. There are currently little data describing the initial clinical manifestations of CD in children in Iran. This study describes the initial presentation of children with suspected CD from a geographically defined region in Iran. Medical records of children seen in 2007 - 2015 from Sistan and Baluchestan province, Iran, with suspected CD were reviewed. After obtaining TTG-IgA and IgA, subjects were divided into three groups according to presenting symptoms: GI, non-GI, and asymptomatic group. Those with elevated TTG-IgA or a strong clinical suspicion for CD underwent endoscopy with duodenal biopsy. Demographic data, symptoms, laboratory, histopathology findings and the presence of any CD related conditions were recorded. from 344 children who underwent upper endoscopy and intestinal biopsy, 105 cases with marsh 0 - 1 were excluded from the study and 239 cases considered as a definite celiac disease (Mean± SD of age was 6.8 ± 3.9 years with 145 females). GI symptoms were predominant in the younger age groups while non-GI symptoms were more common in the older children. The most frequent GI and Non-GI symptoms were abdominal pain (41.4%), distension (36.4%), diarrhea (32.2%), under nutrition (51.4%), anemia (36.4%), and decreased bone age (35%). The most common co-morbidities were hypothyroidism (3.7%) and Type 1 diabetes (2.9%). GI complaints in Iranian children are a common feature. Screening of children with suspected CD, especially with GI symptom is highly recommended.

Posterior Reversible Encephalopathy Syndrome: An Uncommon Presentation of Celiac Disease

Celiac disease is an autoimmune induced inflammatory disease of small intestine in genetically susceptible individuals by ingestion of gluten. Clinical manifestation of celiac disease is mostly gastrointestinal or atypical non-gastrointestinal symptoms or silent with no symptoms, despite the presence of a characteristic intestinal lesion. Wider spectrum of atypical symptoms include neurological syndrome like migraine, encephalopathy, mylopathy, neuropathy with positive antiganglioside antibodies and symptoms of osteomalacia. Autoimmune disorders occur ten times more frequently in adult patients with celiac disease than in the general population such as thyroid disease, type1 diabetes and Addison’s disease etc. If celiac disease remains unrecognized, it can increase the risk of life-threatening complications that are difficult to manage. Herein we are presenting a case of posterior reversible encephalopathy, presenting in department of medicine with seizures. Patient was a diagnosed case of celiac disease.

Celiac Disease in Children: What Has Changed?

The perception of celiac disease (CD) has changed dramatically during the last two decades, with the introduction of new serological tests with high specificity and sensitivity. CD prevalence in recent years is increasing as it is for other autoimmune diseases. Due to the high prevalence of CD, it is one of the most important diseases of the digestive tract. The clinical manifestations of CD have changed significantly in the last two decades, and these are much more diverse than reported previously. The new European Society for Pediatric Gastroenterology, Hepatology, and Nutrition diagnostic criteria for CD indicate that biopsy can be avoided in strictly selected groups of pediatric patients. The first experiences with these new criteria are positive. A meta-analysis evaluating the relationship between early nutrition and the risk of CD recommends that both early ( 7 months) introduction of gluten to the diet should be avoided, and that gluten should be introduced while the infant is still breastfeeding. The prevalence rates of CD between two cohorts with different infant feeding practice were significantly different, and the prevalence of CD in 12-year-old children were significantly reduced, suggesting that prevention of CD is possible.

Serum transglutaminase 3 antibodies correlate with age at celiac disease diagnosis

BackgroundTransglutaminase (TG)2 is the autoantigen in celiac disease, but also TG3 antibodies have been detected in the serum of celiac disease patients. AimsTo investigate the correlations between serum TG3 antibodies and clinical and histological manifestations of celiac disease and to assess gluten-dependency of TG3 antibodies. MethodsCorrelations between serum TG3 antibody levels measured from 119 adults and children with untreated coeliac disease and the demographic data, clinical symptoms, celiac antibodies, histological data and results of laboratory tests and bone mineral densities were tested. TG3 antibodies were reinvestigated in 97 celiac disease patients after 12 months on a gluten-free diet (GFD). ResultsTG3 antibody titers were shown to correlate with the age at celiac disease diagnosis. Further, negative correlation with TG3 antibodies and intestinal γδ+ cells at diagnosis and on GFD was detected. Correlations were not detected with the clinical manifestation of celiac disease, TG2 or endomysial autoantibodies, laboratory values, severity of mucosal villous atrophy, associated diseases or complications. TG3 antibody titers decreased on GFD in 56% of the TG3 antibody positive patients. ConclusionSerum TG3 antibody positivity in celiac disease increases as the diagnostic age rises. TG3 antibodies did not show similar gluten-dependency as TG2 antibodies.