Five year time course of celiac disease serology during gluten free diet: results of a community based "CD-Watch" program.
BACKGROUND
Little information is available on the effect of a follow-up strategy in celiac disease patients during gluten-free diet.


OBJECTIVE
To assess 5 year time course of t-transglutaminase antibodies (t-TG) in celiac disease patients enrolled in a community based follow-up program.


METHODS
Annual t-TG testing and periodical clinic visit in 2245 patients.


RESULTS
Proportion of patients with negative t-TG progressively increased from 83% to 93% during the 5-year follow-up: poor adherence to gluten-free diet (HR 4.764), long duration of gluten-free diet (HR 0.929) and female gender (HR 1.472) were independently associated with serological outcome. In individual patients, 69% tested t-TG "persistently negative", 1% "persistently positive" and 30% "intermittently negative or positive". By applying mathematical modelling to t-TG conversion rates observed in this latter group at beginning and end of the follow-up program, the predicted proportion of t-TG negative population increased from 90% to 95% over 5 years.


CONCLUSIONS
Time-course of t-TG serology in the community fluctuates in 1/3 of celiac disease patients suggesting inconstant adherence to gluten-free diet and need of follow-up strategy. Periodical serological and clinical follow-up is a viable and efficacious strategy to promote adherence to gluten-free diet as inferred from time-course of t-TG serology.
Zanini
Barbara
B
Gastroenterology Unit, University and Spedali Civili of Brescia, Italy.
Lanzarotto
Francesco
F
Mora
Alessandra
A
Bertolazzi
Stefania
S
Turini
Daniele
D
Cesana
Bruno
B
Donato
Francesco
F
Ricci
Chiara
C
Lonati
Fulvio
F
Vassallo
Francesco
F
Scarcella
Carmelo
C
Lanzini
Alberto
A
D000293:Adolescent; D000328:Adult; D000906:Antibodies / Q000032:analysis; D002446:Celiac Disease / Q000097:blood* / Q000178:diet therapy* / Q000276:immunology; D002648:Child; D055050:Diet, Gluten-Free; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012698:Serologic Tests; D013997:Time Factors; D011503:Transglutaminases / Q000097:blood / Q000276:immunology; D055815:Young Adult
D000906:Antibodies; D011503:Transglutaminases