Clinical features of celiac disease: a prospective birth cohort.
OBJECTIVE
To investigate clinical features of celiac disease (CD) and their association with risk factors for CD in a genetic risk birth cohort.


METHODS
Children from 6 clinical centers in 4 countries positive for HLA-DR3-DQ2 or DR4-DQ8 were annually screened for tissue transglutaminase antibodies (tTGA) and assessed for symptoms by questionnaires. Associations of symptoms with anthropometrics, known risk factors for CD, tTGA levels, and mucosal lesions in those biopsied were examined.


RESULTS
Of 6706 screened children, 914 developed persistent positive tTGA, 406 underwent biopsies, and 340 had CD. Compared with age-matched tTGA-negative children, those with persistent tTGA were more likely to have symptoms at 2 (34% vs 19%, P < .001) and 3 years of age (28% vs 19%, P = .009) but not at 4 years (27% vs 21%, NS). Z-scores for height, weight, and BMI did not differ between groups. In children with persistent tTGA, having ≥ 1 symptom was associated with family history of CD (odds ratio = 2.59, 95% confidence interval, 1.21-5.57) but not with age, gender, or HLA-DR3-DQ2 homozygosity. At seroconversion, tTGA levels were higher in symptomatic than asymptomatic children (P < .001), in those from CD families (P < .001), and in US participants (P < .001) but not associated with age, gender, or HLA genotype. tTGA levels correlated with severity of mucosal lesions both in symptomatic (r = 0.53, P < .001) and asymptomatic children (r = 0.22, P = .01).


CONCLUSIONS
A majority of children detected with persistent tTGA in screenings are asymptomatic and have normal growth by age 4 years. tTGA levels correlate more strongly with severity of mucosal lesions in symptomatic as compared with asymptomatic children.
The Diabetes and Celiac Disease Unit, Department of Clinical Sciences, Lund University, Malmo, Sweden; Pediatric Epidemiology Center, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida; daniel.agardh@med.lu.se.
Daniel
D
Agardh
Pediatric Epidemiology Center, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida;
Hye-Seung
HS
Lee
Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland;
Kalle
K
Kurppa
Department of Pediatrics, Turku University Hospital, Turku, Finland;
Ville
V
Simell
The Diabetes and Celiac Disease Unit, Department of Clinical Sciences, Lund University, Malmo, Sweden;
Carin Andrén
CA
Aronsson
The Diabetes and Celiac Disease Unit, Department of Clinical Sciences, Lund University, Malmo, Sweden;
Ola
O
Jörneus
Institute of Diabetes Research, Helmholtz Zentrum München, and Klinikum Rechts der Isar, Technische Universität München, and Forschergruppe Diabetes e.V., Neuherberg, Germany;
Michael
M
Hummel
Digestive Health Institute, University of Colorado, Children's Hospital Colorado, Denver, Colorado; and.
Edwin
E
Liu
Dr von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany.
Sibylle
S
Koletzko
D000293:Adolescent; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics; D005838:Genotype; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007413:Intestinal Mucosa / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors
HLA; celiac disease; screening; symptoms