title: Natural history of potential celiac disease in children.
abstract: OBJECTIVE
  The presence of celiac disease-associated autoantibodies (antiendomysium and antitissue transglutaminase [anti-TG2]) with normal jejunal mucosa indicate potential celiac disease. We performed a prospective, 3-year cohort study to determine the natural history of potential celiac disease in children.
  
  
  METHODS
  The study included 106 children with potential celiac disease, based on serology analysis and normal duodenal architecture. All but 2 carried the HLA-DQ2 and/or DQ8 haplotype. In all children, every 6 months, growth, nutritional parameters, celiac disease serology, and autoimmunity were investigated. In biopsies, γδ intraepithelial-, CD3-, and lamina propria CD25-positive cells were counted; duodenal deposits of anti-TG2 immunoglobulin A were detected. Biopsy analysis was repeated after 2 years on patients with persistent positive serology and/or symptoms.
  
  
  RESULTS
  Celiac disease was detected primarily in first-degree relatives and patients with autoimmune disorders (40.6%). A gluten-free diet was prescribed to 20/106 patients because of symptoms, which were relieved in only 11. Eighty-nine of the 106 patients entered the follow-up study, with normal daily consumption of gluten. During the follow-up antibodies disappeared in 14.6% and fluctuated in 32.6%. Villous atrophy was observed in 12/39 patients (30.8%) who underwent a repeat biopsy.
  
  
  CONCLUSIONS
  Most children with potential celiac disease remain healthy. After 3 years, approximately 33% of patients develop villous atrophy. Intestinal deposits of anti-TG2 IgA identify children at risk for villous atrophy.
authors.affiliation: Department of Pediatrics and European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Tosco
authors.forename: Virginia Michela
authors.initials: VM
authors.lastname: Salvati
authors.forename: Renata
authors.initials: R
authors.lastname: Auricchio
authors.forename: Mariantonia
authors.initials: M
authors.lastname: Maglio
authors.forename: Melissa
authors.initials: M
authors.lastname: Borrelli
authors.forename: Anna
authors.initials: A
authors.lastname: Coruzzo
authors.forename: Francesco
authors.initials: F
authors.lastname: Paparo
authors.forename: Massimo
authors.initials: M
authors.lastname: Boffardi
authors.forename: Antonella
authors.initials: A
authors.lastname: Esposito
authors.forename: Grazia
authors.initials: G
authors.lastname: D'Adamo
authors.forename: Basilio
authors.initials: B
authors.lastname: Malamisura
authors.forename: Luigi
authors.initials: L
authors.lastname: Greco
authors.forename: Riccardo
authors.initials: R
authors.lastname: Troncone
mesh_terms: D000293:Adolescent; D058070:Asymptomatic Diseases; D001323:Autoantibodies / Q000097:blood*; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007413:Intestinal Mucosa / Q000473:pathology*; D007583:Jejunum / Q000473:pathology*; D008297:Male; D011446:Prospective Studies
chemical_list: D001323:Autoantibodies