title: Short-term prognosis of potential celiac disease in Indian patients.
abstract: BACKGROUND
  Progression of potential celiac disease (PCD) to overt celiac disease (CD) has been described in some studies from the Western Hemisphere. There are no Asian data on this aspect of CD.
  
  
  OBJECTIVE
  We aimed to study the short-term histological course of PCD in Indian patients.
  
  
  METHODS
  Patients with PCD were prospectively identified by screening relatives of patients with CD, the diarrheal subtype of irritable bowel syndrome (IBS-D) and patients with iron deficiency anemia (IDA). Patients with serology that was positive for immunoglobulin A antibodies against tissue transglutaminase (IgA anti-tTG) were subjected to endoscopy with duodenal biopsy. PCD was defined as a Marsh-0 to Marsh-II lesion on duodenal biopsy, along with positive IgA tTG serology. Retesting for serology and histology was done at 6-month intervals, for 12 months.
  
  
  RESULTS
  We diagnosed 57 patients (23 male) of mean age 28.7 years (range: 4-73 yrs) as having PCD. Of these 57 patients, 28 were identified by screening 192 first-degree relatives of 55 index cases of CD, while the remaining 29 had either IBS-D or IDA. Duodenal biopsy showed Marsh-0, Marsh-I and Marsh-II changes in 28, 27 and 2 patients, respectively. At 6 months, 12 patients became seronegative. The remaining 45 patients continued to be seropositive at the 12-month time point. Histological progression to Marsh-III occurred in only four patients, while progression from Marsh-0 to either Marsh-I or Marsh-II occurred in six patients and one patient, respectively; but 14 patients with Marsh-I did show regression to Marsh-0. Of the two patients who were initially Marsh-II, one remained so upon follow up and one showed regression to Marsh-0.
  
  
  CONCLUSIONS
  Our data suggested that despite the fact that nearly 80% of the patients diagnosed to have PCD continue to remain seropositive for tTG 12 months later, histological progression to Marsh-III occurred in only 7% of patients over the same time period. These observations do not justify starting a gluten-free diet in all patients with PCD, in India.
authors.affiliation: Department of Gastroenterology, Govind Ballabh Pant Hospital, New Delhi, India.
authors.forename: Raghuram
authors.initials: R
authors.lastname: Kondala
authors.affiliation: Department of Gastroenterology, Govind Ballabh Pant Hospital, New Delhi, India.
authors.forename: Amarender S
authors.initials: AS
authors.lastname: Puri
authors.affiliation: Department of Gastroenterology, Govind Ballabh Pant Hospital, New Delhi, India.
authors.forename: Ameet K
authors.initials: AK
authors.lastname: Banka
authors.affiliation: Department of Gastroenterology, Govind Ballabh Pant Hospital, New Delhi, India.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sachdeva
authors.affiliation: Department of Pathology, Govind Ballabh Pant Hospital, New Delhi, India.
authors.forename: Puja
authors.initials: P
authors.lastname: Sakhuja
keywords: Anemia; India; antibodies; celiac disease; disease progression; gluten; gluten enteropathy; gluten free diet; histology; irritable bowel syndrome; potential celiac disease; risk factors; serology; transglutaminase