Celiac.com 06/01/2016 - People with potential celiac disease (PCD) have blood and genetic markers for celiac disease, but show little or no damage to the small intestinal mucosa.
A research team recently conducted a prospective study to learn more about how the disease progresses in these individuals. The research team included U Volta, G Caio, F Giancola, KJ Rhoden, E Ruggeri, E Boschetti, V Stanghellini, and R De Giorgio. They are all affiliated with the departments of Medical and Surgical Sciences and Digestive System, Centro di Ricerca Biomedica Applicata at the University of Bologna, St Orsola-Malpighi Hospital, Bologna, Italy.
The team assessed clinical, laboratory, and histologic parameters at diagnosis and during a 3-year follow-up period. Forty-six female and 15 male patients, with an average age of 36 years, showed intestinal and extra-intestinal symptoms, whereas the remaining 13 female and 3 male patients, averaging 21 years of age, showed no symptoms at diagnosis.
All subjects tested positive for immunoglobulin A endomysial antibody and tissue transglutaminase antibody, except for 1 patient with immunoglobulin A deficiency; 95% of patients carried the HLA-DQ2 gene. Duodenal biopsies showed that 26% of patients had a Marsh score of 0, while 74% had a Marsh score of 1.
Thirty-six percent of symptomatic patients had autoimmune disorders, and 41% had antinuclear antibodies, compared to just 5% and 12% asymptomatic patients, respectively. Symptomatic patients were generally older at diagnosis (P < .05).
Gluten-free diet led to significant clinical improvement in all 61 symptomatic patients. The 16 asymptomatic patients continued on gluten-containing diets, and only 1 developed mucosal flattening; levels of anti-endomysial and tissue transglutaminase antibodies fluctuated in 5 of these patients or became undetectable.
This 3-year study of adults with potential celiac disease shows that most do have symptoms, which improved on gluten-free diet. However, asymptomatic adults with potential celiac disease do not tend to develop villous atrophy, and so do not require treatment with a gluten-free diet.