Celiac.com 11/08/2007 - A team of doctors led by Christophe Cellier from the Hopital European Georges Pompidou in Paris examined a group people who were diagnosed with celiac disease as children and who tolerated the introduction of gluten into their diets, and continued to consume gluten into their adult years.

A total of 61 patients were evaluated with a bowel biopsy. 13 of the subjects exhibited no indications of the disease, a condition known as latent celiac disease. 48 of the patients without symptoms showed celiac-related intestinal damage, a condition known as silent celiac disease.

The study team observed that a similar ratio of patients with both latent celiac and silent celiac disease exhibited minor symptoms of celiac disease. Both patients with symptoms and those without symptoms had similar indications of malabsorption and similar body mass idices.

Loss of bone density was more common in those with silent celiac disease than in those with latent celiac disease. Patients with silent celiac disease more regularly showed elevated levels of celiac-positive antibodies. As far as clinical symptoms of celiac disease, such as blood and antibody tests, the two groups showed no major differences.

The researchers concluded that even with no symptoms, most people diagnosed with celiac disease as children go on to develop active celiac disease as adults. Such patients should undergo screening for villous atrophy, and osteopenia, and should be encouraged to resume their gluten-free diet in the event that villous atrophy is detected.

Colleagues at Finland’s University of Tampere go so far as to say that even patients with latent celiac disease should follow a strict gluten-free diet. They feel that villous atrophy is only a small part of the equation, and a sign of well-advanced celiac, and that the use of mucosal damage as a standard for diagnosing celiac disease is incomplete and can lead to missed diagnosis and otherwise preventable damage.

Gut 2007; 56: 1379-1386, 1339-1340

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