Follow-up of patients with coeliac disease diagnosed according to clinical criteria in infants and small children

Introduction: In patients with coeliac disease diagnosed according to clinical criteria without initial biopsy there is a need to fulfil all the original ESPGHAN criteria. Aim: The aim of the study was to introduce the follow-up of adult patients with coeliac disease diagnosed according to clinical criteria in infants and small children. Material and methods: Retrospective analysis comprised medical data of 15 adult patients, including 11 female and 4 male, in whom during infancy or in small children the diagnosis of celiac disease according to clinical criteria was made. After returning to a gluten-containing diet endoscopic biopsy of the small intestine with histologic assessment of biopsy specimens according to modified Marsh’s classification and serologic testing concerning presence of IgA and/or IgG serum antiendomysial antibodies using indirect immunofluorescence method were made.
Results: The subjects had had a gluten-free diet for 2-3 years to 38 years. They has been on a gluten-containing diet before evaluation for 0.5 year to 23 years (mean 6.7 years). During gluten-containing diet 5 patients were asymptomatic, but 10 patients did have mild or moderate gastrointestinal symptoms (abdominal pain, bloating, recurrent diarrhoea, aphthous stomatitis, weight loss) and/or nonclassic symptoms (iron-deficient anemia, migraine, skin lesions, oedema). The presence of IgA and/or IgG antiendomysial antibodies was found in 11 patients. Typical histologic changes of the small intestine were found in 9 of 13 biopsied patients, including type IIIC lesions in 4/9, type IIIB in 3/9 and type IIIA in 2/9. In 4 of 13 biopsied patients (including one twice biopsied subject) no histologic abnormalities were found.
Conclusions: In some adult patients with coeliac disease diagnosed according to clinical criteria in infancy or in small children after gluten challenge no histologic abnormalities in the follow-up biopsies can be found.