Original ArticleCeliac Disease without Villous Atrophy in Children: A Prospective Study
Section snippets
Methods
The open study was performed at the Departments of Pediatrics and Gastroenterology and Alimentary Tract Surgery in Tampere University Hospital. The study protocol was approved by the ethical committee of Tampere University Hospital, and all the families gave written informed consent. The EmA-positive patient group comprised 59 consecutive children who were referred from primary health care because of suspicion of celiac disease (Figure 1; available at www.jpeds.com). After baseline
Results
Of the total 59 children who were EmA positive, 17 had normal small-bowel mucosal villous stucture (study group). Of these 17 children, 3 (18%) had Marsh 0 lesions, and 14 (82%) had Marsh I lesions; none had Marsh II lesions. The remaining 42 patients had small-bowel mucosal villous atrophy and crypt hyperplasia (Marsh III) and comprised the celiac group (Figure 1). The EmA-positive study and celiac groups and the seronegative non-celiac group were comparable in age, sex, main symptoms,
Discussion
The results of this trial strengthen the conception that all children who are EmA positive have a gluten-dependent disorder, irrespective of the small-bowel mucosal morphology. There was no difference in the duration or severity of the clinical symptoms in the subjects who were EmA positive with or without villous atrophy, and despite normal mucosal morphology, several celiac disease-related histological markers were detectable in children who were EmA positive. The density of CD3+ IELs in the
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2020, PathologyCitation Excerpt :Furthermore, in our study five (2%) patients had Marsh 1 changes on histology with positive antibody serology and therefore fit diagnostic criteria for potential coeliac disease.7 These patients may either represent early CD or false positive serology, however in children evolvement of potential CD to CD has been reported to occur in 33–100% of cases.33,34 Therefore, it is recommended that patients with potential CD should be monitored clinically, serologically and with further biopsies to detect evolution to CD.7
Diagnostic accuracy and applicability of intestinal auto-antibodies in the wide clinical spectrum of coeliac disease
2020, EBioMedicineCitation Excerpt :In symptomatic patients with positive-serum antibodies and villous atrophy, the CD diagnostic criteria are fulfilled and the diagnosis of classical CD is straightforward. However, thanks to greater awareness of CD, there is an increasing number of symptomatic patients with potential CD, who have positive-serum antibodies despite normal histological intestinal mucosa [6–8], and more patients with pre-potential CD, namely negative or fluctuating serum antibodies and normal intestinal mucosa [4,5,9]. In these two conditions, it has been observed that the presence of intestinal anti-tTG antibodies is the only mucosal immunological marker of CD.
Supported by the Academy of Finland Research Council for Health, the Competitive Research Funding of the Pirkanmaa Hospital District, the Sigrid Juselius Foundation, the Foundation for Paediatric Research, the EU Commission Marie Curie Excellence Grant (FP6 contract MEXT-CT-2005-025270), Marie Curie Mobility Grant (MRTNCT-2006-036032; TRACKS), the National Graduate School of Clinical Investigation, the Ehrnrooth Foundation, and the Finnish Coeliac Society. The study sponsors had no role in the study design or collection, analysis and interpretation of the data, writing of the article or the decision to submit the manuscript for publication. The authors declare no conflicts of interest.