Background & aims: Whether a life-long gluten free diet (GFD) is necessary in asymptomatic children with celiac disease (CD) remains debated. To address this question, we have retrospectively analyzed clinical and biological status of adult celiac patients diagnosed in childhood, who remained on a normal diet after gluten challenge and were clinically silent.
Methods: Patients aged 18-65 years with CD diagnosed in childhood were included. Clinical status, gluten intake, biological parameters of malabsorption, bone mineral density, HLA genotype, serological markers of CD, and histological and immuno-histochemical parameters in duodenal biopsies were recorded.
Results: Sixty one patients had resumed a normal diet and were asymptomatic. Forty eight showed different degrees of villous atrophy (silent CD), while 13 had no detectable atrophy (latent CD) on duodenal biopsies. Latent CD patients had significantly less osteopenia/osteoporosis [1/9 (11%) versus 23/33 (70%), p<0.001)], and lower TcR-αβ+ intraepithelial T cell counts (38±20 vs 55±15, p<0.01) than silent CD patients. The mean age at diagnosis and first GFD was lower in latent than in silent patients (14.4±5 vs 40.1±47 months, p<0.05). Latent patients did not differ significantly from the seven control patients on a long-term GFD, except for a higher frequency of CD-specific serum antibodies. However, two latent patients relapsed clinically and histologically during subsequent follow up.
Conclusions: Long-term latency developed in about 20% of CD patients who remained symptom free after gluten reintroduction. This latency can be transient and thus a regular follow-up is mandatory. In silent patients, the increased risk of osteoporosis substantiates the need of GFD.
- celiac disease
- gluten free diet
- gluten tolerance