Celiac disease without villous atrophy in children: a prospective study.
OBJECTIVE
To establish whether children who are endomysial antibody (EmA) positive and have normal small-bowel mucosal villous morphology are truly gluten-sensitive and may benefit from early treatment with a gluten-free diet.


METHODS
Children who were EmA positive with normal small-bowel mucosal villi were compared with children who were seropositive with villous atrophy by using several markers of untreated celiac disease. Thereafter, children with normal villous structure either continued on a normal diet or were placed on a gluten-free diet and re-investigated after 1 year. Seventeen children who were seronegative served as control subjects for baseline investigations.


RESULTS
Normal villous morphology was noted in 17 children who were EmA positive, and villous atrophy was noted in 42 children who were EmA positive. These children were comparable in all measured variables regardless of the degree of enteropathy, but differed significantly from the seronegative control subjects. During the dietary intervention, in children who were EmA positive with normal villi, the disease was exacerbated in children who continued gluten consumption, whereas in all children who started the gluten-free diet, both the gastrointestinal symptoms and abnormal antibodies disappeared.


CONCLUSIONS
The study provided evidence that children who are EmA positive have a celiac-type disorder and benefit from early treatment despite normal mucosal structure, indicating that the diagnostic criteria for celiac disease should be re-evaluated.
Kurppa
Kalle
K
Pediatric Research Centre, University of Tampere and Tampere University Hospital, Tampere, Finland.
Ashorn
Merja
M
Iltanen
Sari
S
Koskinen
Lotta L E
LL
Saavalainen
Päivi
P
Koskinen
Outi
O
Mäki
Markku
M
Kaukinen
Katri
K
D000293:Adolescent; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D055050:Diet, Gluten-Free; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D055815:Young Adult