Potential coeliac disease in children: a single-center experience

Luisa Lonoce; Simona Ferraro; Luca Lalli; Luisa Abbattista; Chiara Hruby; Cristina Cocuccio; Cecilia Mantegazza; Elena Groppali; Fabio Pasotti; Francesca Severino; Gianvincenzo Zuccotti; Elena Pozzi

doi:10.1515/cclm-2025-0098

Article

Potential coeliac disease in children: a single-center experience

Luisa Lonoce , Simona Ferraro , Luca Lalli , Luisa Abbattista , Chiara Hruby , Cristina Cocuccio , Cecilia Mantegazza , Elena Groppali , Fabio Pasotti , Francesca Severino , Gianvincenzo Zuccotti and Elena Pozzi

Published/Copyright: April 25, 2025

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From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 63 Issue 9

Abstract

Objectives

Potential coeliac disease (PCD) is defined by the presence of positive CD-specific autoantibodies with a normal/extremely mildly damaged intestinal mucosa. This study sought to examine the progression of PCD in children maintaining a gluten-containing diet and to identify risk factors associated with the onset of CD. A comparative literature review was conducted to assess the results in the context of existing evidence.

Methods

A retrospective cohort study was performed on 67 children diagnosed with PCD between January 2005 and January 2022, with a maximum follow up of 53 months. The associations between baseline clinical characteristics and the development of CD were assessed using hazard ratios (HR).

Results

Nineteen percent (19 %) (12/67, cumulative incidence) of PCD children, with a median age of 4.3 years, progressed to CD during a median follow up period of 30 months. A fluctuating trend in tissue transglutaminase IgA (tTG-IgA) levels was observed in 35.8 % (24/67) of the children, while 46.2 % (31/67) showed tTG-IgA negativization. In univariable analysis, the presence of autoimmune disease and one-year increase in age at diagnosis were significantly associated with CD progression [HR=17.7 (95%CI: 3.0–106.8; p=0.0017) and HR=1.3 (95%CI: 1.1–1.5; p=0.0125), respectively].

Conclusions

Our study confirms that only a small proportion of PCD children progress to CD. It also highlights that advancing age and the presence of autoimmune disease are the main risk factors for the development of villous atrophy. A better understanding of tTG-IgA trend during follow up could help in the management of PCD children.

Keywords: children; potential celiac disease; gluten; biopsy; villous atrophy; tissue transglutaminase IgA

Corresponding author: Simona Ferraro, Pediatric Department, Buzzi Children’s Hospital, Milan, Italy, E-mail: simona.ferraro@asst-fbf-sacco.it

Luisa Lonoce and Simona Ferraro contributed equally to this work.

Acknowledgments

The authors wish to thank the Fondazione Buzzi for their support of this study.

Research ethics: This study was approved by the Local Ethics Committee LOMBARDIA 1 (protocol n # CET 347-2024 dated September 25, 2024). The research was conducted using data collected during the daily clinical care of the patients. All procedures adhered to the guidelines set by the Local Ethical Committee and were conducted in accordance with the ethical standards outlined in the 1964 Helsinki Declaration and its subsequent amendments. Informed consent was obtained for the treatment of anonymized data from a parent or a legal guardian.
Informed consent: Informed consent was obtained from all individuals included in this study, or their legal guardians or wards.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. The authors Lu.Lo., and E.P. were involved in the provision of study material and conceptualization; L.A., C.C., C.H., C.M., E.G., were involved in the provision of study material; Lu.Lo., E.P., S.F. wrote the draft; F.S. performed language editing and improved the manuscript’s clarity; F.P. was involved in retrieving EQA data; Lu.La., S.F. were involved in the statistical analysis; G.Z. revised and approved the final draft.
Use of Large Language Models, AI and Machine Learning Tools: None declared.
Conflict of interest: The authors state no conflict of interest.
Research funding: None declared.
Data availability: The raw data can be obtained on request from the corresponding author.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/cclm-2025-0098).

Received: 2025-01-24

Accepted: 2025-04-14

Published Online: 2025-04-25

Published in Print: 2025-08-26

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Keywords for this article

children; potential celiac disease; gluten; biopsy; villous atrophy; tissue transglutaminase IgA