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. 2015 Apr;135(4):627-34.
doi: 10.1542/peds.2014-3675. Epub 2015 Mar 2.

Clinical features of celiac disease: a prospective birth cohort

Daniel Agardh  1 , Hye-Seung Lee  2 , Kalle Kurppa  3 , Ville Simell  4 , Carin Andrén Aronsson  5 , Ola Jörneus  5 , Michael Hummel  6 , Edwin Liu  7 , Sibylle Koletzko  8 ; TEDDY Study Group
Collaborators, Affiliations

Clinical features of celiac disease: a prospective birth cohort

Daniel Agardh et al. Pediatrics. 2015 Apr.

Abstract

Objectives: To investigate clinical features of celiac disease (CD) and their association with risk factors for CD in a genetic risk birth cohort.

Methods: Children from 6 clinical centers in 4 countries positive for HLA-DR3-DQ2 or DR4-DQ8 were annually screened for tissue transglutaminase antibodies (tTGA) and assessed for symptoms by questionnaires. Associations of symptoms with anthropometrics, known risk factors for CD, tTGA levels, and mucosal lesions in those biopsied were examined.

Results: Of 6706 screened children, 914 developed persistent positive tTGA, 406 underwent biopsies, and 340 had CD. Compared with age-matched tTGA-negative children, those with persistent tTGA were more likely to have symptoms at 2 (34% vs 19%, P < .001) and 3 years of age (28% vs 19%, P = .009) but not at 4 years (27% vs 21%, NS). Z-scores for height, weight, and BMI did not differ between groups. In children with persistent tTGA, having ≥ 1 symptom was associated with family history of CD (odds ratio = 2.59, 95% confidence interval, 1.21-5.57) but not with age, gender, or HLA-DR3-DQ2 homozygosity. At seroconversion, tTGA levels were higher in symptomatic than asymptomatic children (P < .001), in those from CD families (P < .001), and in US participants (P < .001) but not associated with age, gender, or HLA genotype. tTGA levels correlated with severity of mucosal lesions both in symptomatic (r = 0.53, P < .001) and asymptomatic children (r = 0.22, P = .01).

Conclusions: A majority of children detected with persistent tTGA in screenings are asymptomatic and have normal growth by age 4 years. tTGA levels correlate more strongly with severity of mucosal lesions in symptomatic as compared with asymptomatic children.

Keywords: HLA; celiac disease; screening; symptoms.

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Figures

FIGURE 1
FIGURE 1
tTGA levels in 179 children undergoing intestinal biopsies and categorized according to Marsh score (M) with and without reporting clinical symptoms (spt). We obtained P values by using a general linear model after adjusting for country, gender, and HLA.
See this image and copyright information in PMC

Comment in

  • Another step towards celiac screening.
    Noel RJ. Noel RJ. Pediatrics. 2015 Apr;135(4):752-3. doi: 10.1542/peds.2015-0209. Epub 2015 Mar 2. Pediatrics. 2015. PMID: 25733748 Free PMC article. No abstract available.

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