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Coeliac disease
Original research
Clinical outcomes of potential coeliac disease: a systematic review and meta-analysis
  1. Mohamed G Shiha1,2,
  2. Annalisa Schiepatti3,4,
  3. Stiliano Maimaris3,4,
  4. NIcoletta Nandi1,5,
  5. Hugo A Penny1,2,
  6. David S Sanders1,2
  1. 1Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  2. 2Division of Clinical Medicine, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
  3. 3Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
  4. 4Gastroenterology Unit of Pavia Institute, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy
  5. 5Department of Pathophysiology and Organ Transplantation, University of Milan, Milano, Italy
  1. Correspondence to Dr Mohamed G Shiha, Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Sheffield, UK; mohamed.shiha1{at}nhs.net

Abstract

Objective Potential coeliac disease (PCD) is characterised by positive serological and genetic markers of coeliac disease with architecturally preserved duodenal mucosa. The clinical outcomes and rates of progression to overt coeliac disease in patients with PCD remain uncertain. In this systematic review and meta-analysis, we aimed to evaluate the clinical outcomes of patients with PCD.

Design We searched Medline, Embase, Scopus and Cochrane Library from 1991 through May 2024 to identify studies evaluating the clinical outcomes of patients with PCD. The progression rates to villous atrophy, seroconversion and response to a gluten-free diet (GFD) were analysed. A random-effect meta-analysis was performed, and the results were reported as pooled proportions with 95% CIs.

Results Seventeen studies comprising 1010 patients with PCD were included in the final analyses. The pooled prevalence of PCD among patients with suspected coeliac disease was 16% (95% CI 10% to 22%). The duration of follow-up in most of the studies was at least 1 year, with follow-up periods within individual studies ranging from 5 months to 13 years. During follow-up, 33% (95% CI 18% to 48%; I2=96.4%) of patients with PCD on a gluten-containing diet developed villous atrophy, and 33% (95% CI 17% to 48%; I2=93.0%) had normalisation of serology. Among those who adhered to a GFD, 88% (95% CI 79% to 97%; I2=93.2%) reported symptomatic improvement.

Conclusion Almost a third of patients with PCD develop villous atrophy over time, whereas a similar proportion experience normalisation of serology despite a gluten-containing diet. Most symptomatic patients benefit from a GFD. These findings highlight the importance of structured follow-up and individualised management for patients with PCD.

  • coeliac disease
  • gluten

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/gutjnl-2024-333110

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • X @Mo_shiha

    • Contributors Conception and design: MGS and AS. Data collection and extraction: MGS, SM and NN. Data analyses and drafting of the manuscript: MGS. Data interpretation and critical revisions of the manuscript: all authors. All authors approved the final draft of the manuscript. MGS is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.