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Symptoms and signs in individuals with serology positive for celiac disease but normal mucosa.
BMC Gastroenterol 2009; 9:57BG

Abstract

BACKGROUND

Antibody serology is an important tool in the investigation of celiac disease (CD), but does not always correlate with mucosal appearance in the small intestine. Patients with positive CD serology but normal mucosa (Marsh 0) are at increased risk of future CD. In this study we describe a model for identifying and characterizing individuals with normal mucosa but positive CD serology. Such individuals are sometimes referred to as having latent CD.

METHODS

The records of ten Swedish pathology departments were used to identify individuals with biopsies indicating normal duodenal/jejunal mucosa. Using the national personal identification number, these data were linked with CD serology data (antigliadin, antiendomysial and tissue transglutaminase antibodies); and we thereby identified 3,736 individuals with normal mucosa but positive CD serology. Two independent reviewers then manually reviewed their biopsy reports to estimate comorbidity. We also randomly selected 112 individuals for validation through patient chart review.

RESULTS

The majority of the 3,736 individuals were females (62%). Children (0-15 years) made up 21.4%. The median number of biopsy specimen was 3. Our review of biopsy reports found that other gastrointestinal comorbidity was rare (inflammatory bowel disease: 0.4%; helicobacter pylori infection: 0.2%). Some 22% individuals selected for patient chart review had a relative with CD. The most common symptoms among these individuals were diarrhea (46%) and abdominal pain (45%), while 26% had anemia. Although 27% of the individuals selected for validation had been informed about gluten-free diet, only 13% were adhering to a gluten-free diet at the end of follow-up.

CONCLUSION

Individuals with positive CD serology but normal mucosa often have CD-like symptoms and a family history of CD.

Authors+Show Affiliations

Department of Pediatrics, Orebro University Hospital, Sweden. jonasludvigsson@yahoo.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19624815

Citation

Ludvigsson, Jonas F., et al. "Symptoms and Signs in Individuals With Serology Positive for Celiac Disease but Normal Mucosa." BMC Gastroenterology, vol. 9, 2009, p. 57.
Ludvigsson JF, Brandt L, Montgomery SM. Symptoms and signs in individuals with serology positive for celiac disease but normal mucosa. BMC Gastroenterol. 2009;9:57.
Ludvigsson, J. F., Brandt, L., & Montgomery, S. M. (2009). Symptoms and signs in individuals with serology positive for celiac disease but normal mucosa. BMC Gastroenterology, 9, p. 57. doi:10.1186/1471-230X-9-57.
Ludvigsson JF, Brandt L, Montgomery SM. Symptoms and Signs in Individuals With Serology Positive for Celiac Disease but Normal Mucosa. BMC Gastroenterol. 2009 Jul 22;9:57. PubMed PMID: 19624815.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Symptoms and signs in individuals with serology positive for celiac disease but normal mucosa. AU - Ludvigsson,Jonas F, AU - Brandt,Lena, AU - Montgomery,Scott M, Y1 - 2009/07/22/ PY - 2009/04/01/received PY - 2009/07/22/accepted PY - 2009/7/24/entrez PY - 2009/7/25/pubmed PY - 2009/10/22/medline SP - 57 EP - 57 JF - BMC gastroenterology JO - BMC Gastroenterol VL - 9 N2 - BACKGROUND: Antibody serology is an important tool in the investigation of celiac disease (CD), but does not always correlate with mucosal appearance in the small intestine. Patients with positive CD serology but normal mucosa (Marsh 0) are at increased risk of future CD. In this study we describe a model for identifying and characterizing individuals with normal mucosa but positive CD serology. Such individuals are sometimes referred to as having latent CD. METHODS: The records of ten Swedish pathology departments were used to identify individuals with biopsies indicating normal duodenal/jejunal mucosa. Using the national personal identification number, these data were linked with CD serology data (antigliadin, antiendomysial and tissue transglutaminase antibodies); and we thereby identified 3,736 individuals with normal mucosa but positive CD serology. Two independent reviewers then manually reviewed their biopsy reports to estimate comorbidity. We also randomly selected 112 individuals for validation through patient chart review. RESULTS: The majority of the 3,736 individuals were females (62%). Children (0-15 years) made up 21.4%. The median number of biopsy specimen was 3. Our review of biopsy reports found that other gastrointestinal comorbidity was rare (inflammatory bowel disease: 0.4%; helicobacter pylori infection: 0.2%). Some 22% individuals selected for patient chart review had a relative with CD. The most common symptoms among these individuals were diarrhea (46%) and abdominal pain (45%), while 26% had anemia. Although 27% of the individuals selected for validation had been informed about gluten-free diet, only 13% were adhering to a gluten-free diet at the end of follow-up. CONCLUSION: Individuals with positive CD serology but normal mucosa often have CD-like symptoms and a family history of CD. SN - 1471-230X UR - https://www.unboundmedicine.com/medline/citation/19624815/Symptoms_and_signs_in_individuals_with_serology_positive_for_celiac_disease_but_normal_mucosa_ L2 - https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-9-57 DB - PRIME DP - Unbound Medicine ER -