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Normalization Time of Celiac Serology in Children on a Gluten-free Diet

Gidrewicz, Dominica*; Trevenen, Cynthia L.*,†; Lyon, Martha; Butzner, J. Decker*

Journal of Pediatric Gastroenterology and Nutrition: March 2017 - Volume 64 - Issue 3 - p 362–367
doi: 10.1097/MPG.0000000000001270
Original Article: Gastroenterology: Celiac Disease

Objectives: Response to a gluten-free diet (GFD) in children with celiac disease is determined by symptom resolution and normalization of serology. We evaluated the rate of normalization of the transglutaminase (TTG) and antiendomysial (EMA) for children on a GFD after diagnosis.

Methods: Celiac serologies were obtained over 3.5 years after starting a GFD in 228 newly diagnosed children with biopsy-proven celiac disease. Patients were classified into categories based on serology (group A, TTG ≥10 × upper limit of normal [ULN] and EMA ≥ 1:80; group B, TTG ≥10 × ULN and EMA ≤ 1:40; and group C, TTG <10 × ULN) and by severity of histologic injury at diagnosis.

Results: In children with the highest serology at diagnosis (group A), 79.7% had an abnormal TTG at 12 months after diagnosis (mean TTG 12 months, 68.8 ± 7.3, normal <20 kU/L). At 2 years, an abnormal TTG persisted in 41.7%. In contrast, only 35% of children with the lowest serology at diagnosis (group C) displayed an abnormal TTG at 12 months (mean TTG 14.3 ± 1.9 kU/L). In those with the most severe mucosal injury, Marsh 3C, 74.2% and 33.2% had an abnormal TTG at 1 and 2 years.

Conclusions: Normalization of celiac serology took >1 year in approximately 75% of GFD-compliant children with the highest celiac serology or most severe mucosal injury at diagnosis. Clinicians must consider serology and histology at diagnosis to properly evaluate response to GFD.

*Department of Pediatrics

Department of Pathology and Laboratory Medicine, University of Calgary, Calgary

Department of Pathology and Laboratory Medicine, Saskatoon Health Region, Saskatoon, Canada.

Address correspondence and reprint requests to Dominica Gidrewicz, MD, Alberta Children's Hospital, 2888 Shaganappi Trail, Calgary, AB T3B 6A8, Canada (e-mail:

Received 23 January, 2016

Accepted 19 May, 2016

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The present study was supported by the Canadian Celiac Association—Calgary Chapter.

The authors report no conflicts of interest.

© 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,