Progression of celiac disease in children with antibodies against tissue transglutaminase and normal duodenal architecture

Аннотация

Celiac disease (CD) is a chronic autoimmune enteropathy triggered by gluten ingestion in genetically predisposed individuals. While the classic presentation involves intestinal damage, a subset of children presents with positive celiac-specific antibodies, particularly against tissue transglutaminase (tTG), but have normal or near-normal duodenal villous architecture upon biopsy. This condition is often referred to as potential celiac disease (PCD). Understanding the natural history and factors influencing the progression from PCD to overt CD (characterized by mucosal atrophy) is crucial for clinical management. This article synthesizes findings from recent studies to explore the progression of CD in children with positive tTG antibodies and initially normal duodenal architecture. It examines factors associated with progression, potential biomarkers, and current diagnostic and management approaches for this specific pediatric population. Keywords: Celiac Disease, Tissue Transglutaminase Antibodies, Pediatric Gastroenterology, Duodenal Architecture, Antibody Testing, Pediatric Immunology, Gluten Sensitivity, Disease Progression, Gluten-Free Diet, Children’s Health, Gastrointestinal Disorders, Intestinal Biopsy, Immune Response, Chronic Autoimmune Diseases, Serology Markers, Early Diagnosis. children may remain stable with positive antibodies but Introduction: Celiac disease is a common condition no mucosal damage, while others will progress to affecting both children and adults, characterized by an develop the characteristic villous atrophy of overt CD immune response to gluten that leads to inflammation over time (Auricchio et al., 2019) [1]. The decision to and damage in the small intestine (Abadie et al., 2024) implement a gluten-free diet (GFD) in children with PCD [7]. The diagnosis typically relies on a combination of is a subject of ongoing debate and varies between positive celiac-specific antibodies, such as anti-tissue clinical guidelines (Nemteanu et al., 2023) [6]. transglutaminase (tTG) antibodies, and characteristic Predicting which children with PCD will progress to histological changes in duodenal biopsies, including overt CD is a key challenge in pediatric villous atrophy (Marsh stage 3) (Auricchio et al., 2019) gastroenterology (Piccialli et al., 2021) [14]. This article [1]. However, a significant number of children are aims to review recent research on the progression of identified with positive celiac serology but show no or CD in children presenting with positive tTG antibodies minimal damage to the intestinal mucosa (Marsh stage and normal duodenal architecture, highlighting insights 0 or 1) upon initial biopsy (Auricchio et al., 2019) [1]. into predictive factors, diagnostic strategies, and This clinical scenario is often termed potential celiac potential future directions. disease (PCD) (Nemteanu et al., 2023) [6]. METHODS The trajectory of PCD in children is variable; some International Journal of Medical Sciences And Clinical Research 1 https://theusajournals.com/index.php/ijmscr International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265) This article is based on a narrative review and synthesis biomarkers that could indicate mucosal lesion of the provided scientific literature focusing on the progression in pediatric CD (Vitale et al., 2021) [9, 26]. progression of celiac disease in children, particularly New intraepithelial γδ T-lymphocyte markers are being those with positive serology and normal duodenal investigated for their potential in classifying CD in architecture. The included references consist of original duodenal biopsies (Popp et al., 2021) [24]. Molecular research articles, review articles, and conference biomarkers are also being explored for their role in the abstracts published between 2019 and 2024. past, present, and future diagnosis and understanding of CD (Ramírez-Sánchez et al., 2020) [17, 31]. The approach involved reviewing each provided reference to identify key findings, methodologies, and Diagnostic approaches for children with positive conclusions related to: serology and normal mucosa are evolving. While duodenal biopsy remains a key diagnostic tool, 1. The definition and characteristics of potential particularly in cases with high-titer serology, there are celiac disease in children. ongoing discussions and variations in biopsy policies 2. The rate and factors associated with the between regions like Europe and North America progression from potential to overt celiac disease. (Badizadegan et al., 2020) [19]. Novel diagnostic tests, 3. The role of celiac-specific antibodies (especially such as intestinal and blood lymphograms, are being tTG) in predicting progression. explored (Roy et al., 2023) [4, 28]. Dual sugar 4. The significance of duodenal histology in the absorption tests, using monosaccharides like rhamnose context of positive serology. and mannitol, are also being evaluated for their utility in treatment-naïve children w