What is the Best Strategy for Children with Celiac Disease?

Most children with potential celiac disease, based on serologic markers, remain healthy after 3 years—only about a third develop villous atrophy, report Antonella Tosco et al. in the April issue of Clinical Gastroenterology and Hepatology. However, antibody tests can identify children at greatest risk for the changes in the intestinal villi that are typically associated with celiac disease (villous atrophy).

Several tests are used to screen children for potential celiac disease—these include measurement and localization of intraepithelial lymphocytes and serologic tests for auto-antibodies. But what should be done when a child has a positive test result but no symptoms or villous atrophy?

Tosco et al. followed 106 children who had potential celiac disease based on serologic analysis for anti-endomysium and anti-tissue transglutaminase; none of the children had villous atrophy, based on analysis of biopsy samples.

Twenty children were placed on a gluten-free diet because they eventually developed symptoms, which were relieved in only 11. The other 86 children consumed normal, daily amounts of gluten. The auto-antibodies disappeared in 14.6% and levels fluctuated in 32.6%. After 2 years, 39 underwent a second biopsy analysis, and 31% were found to have developed villous atrophy.

In biopsy samples, transglutaminase deposits were a better predictor of which children would develop villous atrophy than other factors (see below figure). Transglutaminase deposits were present in the biopsy sample from 92% of the children who developed villous atrophy, compared with 59% who did not.

Antibody deposits (green) in duodenal mucosa from a patient with potential celiac disease, with subepithelial localization of transglutaminase (red).

In an accompanying editorial, Edward Hoffenberg and Edwin Liu warn that autoimmunity to antigens associated with celiac disease, even in patients with normal villous architecture, cannot be ignored. They state that it is premature to propose general changes to patient care without a good way to identify which subsets of seropositive patients will go on to develop villous atrophy, and which patients without symptoms will develop long-term complications.

More Information on Celiac Disease:

Read the article online. This article has accompanying CME.
Tosco A, Salvati VM, Auricchio T, et al. Natural history of potential celiac disease in children. Clin Gastroenterol and Hepatol 2011;9:320–325.

Read the accompanying editorial.
Hoffenberg EJ and Liu E. Screening-identified celiac disease: who needs treatment and when? Clin Gastroenterol and Hepatol 2011;9:284–285.

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About Kristine Novak, PhD, Science Editor

Dr. Kristine Novak is the science editor for Gastroenterology and Clinical Gastroenterology and Hepatology, both published by the American Gastroenterological Association. She has worked as an editor at biomedical research journals and as a science writer for more than 12 years, covering advances in gastroenterology, hepatology, cancer, immunology, biotechnology, molecular genetics, and clinical trials. She has a PhD in cell biology and an interest in all areas of medical research.
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One Response to What is the Best Strategy for Children with Celiac Disease?

  1. Dear Dr. Novak,
    In january of 2011 there was a printed by AGA which dealt with fermented wheat bread and its result on celiacs. It has always been my contention that gluten would not be the culprit if a celiac had sufficient enzyme activity to break the protein down before it ever reached the duodenum. The problem could be enzyme inhibitors in wheat that are necessary to protect against insect activity because wheat is a naked grain and it could be partially due to a hormone that has turned off some of the peptidase in the stomach (this is similar to rennet in a calves stomach) which could be turned off in the adult cow once it is on a plant based diet, it could also be partially due to the fact that wheat gluten is so tough and is not easily broken down by water and mixing.

    A grain product that we have quietly marketed for the last 25+ years has shown the same results against inflammatory diseases that are now touted by the manufacturers of gluten free foods. We also have a wide complement of consumers who are biopsied celiacs who find they can eat the product.

    With health care costs ever escalating and no known cure for these inflammatory illnesses, a spelt based diet could prove to be helpful for thoulsands of people if science could confirm our observations taken from conversations with satisfied customers they might even be able to advance a cure for celiac disease.

    Why the agencies and researchers dealing with celiac have ignored claims by celiacs who have found releif is beyond me.

    Can you give me some direction as to who may be conducting meaningful research in this area and who look at anecdotal information as honest observations in support of a theory?

    I would be interested in talking to you about this and would answer any question to the best of my ability.

    Sincerely,

    Don Stinchocmb – President
    Purity Foods, Inc. 800 997 7358

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