Most children with potential celiac can continue to eat gluten and will never develop overt disease, according to research from Italy. Potential celiac is a condition in which patients develop typical blood antibodies but without damage to the small intestine. Patients may or may not have celiac-like symptoms. In this 10-year study, most cases spontaneously reverted to normal blood antibodies and remained healthy while consuming gluten.
The data came from a larger study attempting to understand how celiac develops. It is following from birth 553 children who are genetically at risk for the disease. Twenty-six individuals were diagnosed with potential celiac, all without symptoms. Biopsies showed a healthy intestinal lining. These diagnoses all occurred between age 15 months and 5 years. Parents of three children chose to start them on a gluten-free diet.
Twenty-three children continued a normal diet and were screened again for blood antibodies every year. If antibodies remained high or reappeared later, the patients underwent further biopsies. From this group, 19 children reverted to normal antibodies a year after their first biopsy and did not develop any autoimmune disease within 10 years. Three of this group (14 percent) developed celiac within three years of the first biopsy. One patient showed fluctuating antibodies, but their healthy gut persisted.
These findings will inform the debate about whether to start children with potential celiac on a gluten-free diet, especially if they lack symptoms. The authors suggest that in families with celiac history, children who test positive for blood antibodies should always undergo a biopsy to confirm a diagnosis before adopting a gluten-free diet for life. If the intestinal lining remains healthy, children can continue consuming gluten but should receive regular blood tests to make sure antibodies return to normal. Most young children with elevated antibodies will likely revert to normal and never develop celiac. However, the continued presence of antibodies indicates a high risk for developing celiac and calls for careful follow-up. The ongoing study will continue to monitor these patients.
The study notes that one of the three children who started a gluten-free diet later developed autoimmune thyroiditis. The authors suggest this contradicts the theory that a gluten-free diet protects children with potential celiac.
Lionetti E, Castellaneta S, Francavilla R, Pulvirenti A, Catassi GN, Catassi C. Long-term outcome of potential celiac disease in genetically at-risk children: the prospective CELIOREV cohort study. Journal of Clinical Medicine. 2019; 8;186. doi:10.3390/jcm8020186.