Potential Celiac Disease

Potential celiac disease refers to patients who are diagnosed with gluten sensitivity by a positive TTG-IgA or endomysial antibody but who have a normal small bowel biopsy. For these patients, management decisions are based on the presence of symptoms. For children who are truly asymptomatic, a gluten-free diet is not recommended. 

Because a child may not effectively communicate about symptoms that may herald active disease, periodic reevaluation for symptoms and appropriate growth is important. An additional endoscopy with re-biopsy should be performed when appropriate in high-risk patients (eg, those who develop gastrointestinal symptoms and/or have rising titers of celiac serologic tests). However, A “No Biopsy” approach can also be considered if parents are not consenting(Read previous post)**

Before considering a patient to have potential celiac disease, it is important to repeat the antibody testing and to make certain that the intestinal biopsies were adequate. In addition,  further serologic testing using a second specific antibody (eg, anti-endomysial IgA antibodies) is recommended. HLA testing for DQ2 nor DQ8 genotype may also be helpful, though recent ESPGHAN 2019 guidelines do not mandate it for confirmation.

Read Previous Update on Celiac Diagnosis

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