Prevalence and Natural History of Potential Celiac Disease in At-Family-Risk Infants Prospectively Investigated from Birth

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• 作者：Elena Lionetti ; MD ; PhD¹ ; Stefania Castellaneta ; MD² ; Alfredo Pulvirenti ; PhD³ ; Elio Tonutti ; MD⁴ ; Ruggiero Francavilla ; PhD⁵ ; Alessio Fasano ; MD ; PhD⁶ ; Carlo Catassi ; MD ; PhD⁶ ; ⁷ ; ^{catassi@tin.it} ; Italian Working Group of Weaning ; Celiac Disease Risk &lowast
• 关键词：AGA ; Anti-gliadin antibodies ; CD ; Celiac disease ; EMA ; Anti-endomysial antibodies ; ESPGHAN ; European Society for Pediatric Gastroenterology ; Hepatolgy ; and Nutrition ; GFD ; Gluten-free diet ; HLA ; Human leukocyte antigen ; tTG ; Anti-tissue transglutaminase
• 刊名：The Journal of Pediatrics
• 出版年：2012
• 出版时间：November, 2012
• 年：2012
• 卷：161
• 期：5
• 页码：908-914.e2
• 全文大小：400 K

文摘

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Objective

To evaluate the frequency and the natural history of potential (serology positive/Marsh 0-1 histology) celiac disease (CD) in children with a family risk of CD and factors associated with potential instead of overt (serology positive/Marsh 2-3 histology) CD expression.

Study design

Two-year follow-up study of 96 children (57 females; mean age: 29 ¡À 12 months) prospectively investigated from birth with: (1) a CD-affected first-degree relative; (2) positivity of serum IgA anti-tissue transglutaminase (tTG) or IgG antigliadin and IgA deficiency; and (3) the results of small intestinal biopsy. Children with potential CD were advised to remain on a gluten containing diet, repeat the celiac antibodies every 6 months, and to have an intestinal biopsy performed in case of persistently high anti-tTG level. Factors discriminating between potential and overt CD were analyzed by decision tree analysis based on the C4.5 algorithm.

Results

Twenty-four children had potential and 72 overt CD. The stronger predictors of potential CD were lack?of symptoms, anti-tTG level lower than 11-fold the upper normal limit, age lower than 24 months, and breastfeeding longer than 8 months. Eighteen out of 21 (86 % ) patients with potential CD continuing a gluten-containing diet became antibody negative, 1/21 (5 % ) developed overt CD, and 2/21 (9 % ) had fluctuating antibodies levels after 2 years.

Conclusions

The prevalence of potential CD and the percentage of short-term loss of CD-related-antibodies are high in infants at-family-risk for CD. In symptomless children with a positive celiac serology, the decision of performing an intestinal biopsy should be preceded by a period of repeated serological testing.