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.