PediatricsPotential Celiac Children: 9-Year Follow-Up on a Gluten-Containing DietAuricchio, Renata MD, PhD1; Tosco, Antonella MD1; Piccolo, Emanuela MD1; Galatola, Martina PhD1; Izzo, Valentina PhD1; Maglio, Mariantonia PhD1; Paparo, Francesco PhD1; Troncone, Riccardo MD, PhD1; Greco, Luigi MD, PhD1Author Information 1 Department of Medical Translational Science, European Laboratory for the Investigation of Food Induced Disease (ELFID), University Federico II, Naples, Italy Correspondence: Renata Auricchio, Department of Pediatrics, European Laboratory for the Investigation of Food Induced Disease (ELFID), Via S Pansini 5, 80131 Naples, Italy. E-mail: email@example.com SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A941 Received 5 July 2013; accepted 28 February 2014 published online 22 April 2014 American Journal of Gastroenterology: June 2014 - Volume 109 - Issue 6 - p 913-921 doi: 10.1038/ajg.2014.77 Buy SDC Metrics Abstract OBJECTIVES: Potential celiac disease (CD) is defined by the presence of serum anti-tissue-transglutaminase (anti-TG2) antibodies and normal duodenal mucosa. The major clinical problem is the management of asymptomatic patients and how to predict the development of villous atrophy. This prospective longitudinal cohort study describes the natural history of potential CD up to 9 years and explores risk factors associated with the development of mucosal damage. METHODS: Two hundred and ten potential CD children were eligible for the study; 175/210 asymptomatic children were left on a gluten-containing diet. Antibodies and clinical symptoms were checked every 6 months, and a small bowel biopsy was taken every 2 years to evaluate histological, immunohistochemical, and anti-TG2 deposits. Patients were genotyped for HLA and a set of non-HLA CD-associated genes. RESULTS: Forty-three percent of patients showed persistently elevated anti-TG2 level, 20% became negative during follow-up, and 37% showed a fluctuant anti-TG2 course with transiently negative values. At 3 years of follow-up, 86% of cases remained potential; 73 and 67% still had normal duodenal architecture at 6 and 9 years, respectively. Male sex, slight mucosal inflammation at time 0, and a peculiar genetic profile delineate a cohort of individuals who were prone to develop mucosal damage during time. CONCLUSIONS: A sizeable proportion of asymptomatic potential celiac patients showed fluctuation or negativization of antibody production, and many of these, with persistently positive anti-TG2, did not develop mucosal damage after 9 years of follow-up. Celiac population is a multivariate aggregate of individuals with different genetic and phenotypic profiles. Caution is required before prescribing a gluten-free diet for life to asymptomatic individuals with potential CD. © The American College of Gastroenterology 2014. All Rights Reserved.