This study supports what we at the IBS Treatment Center have been saying for years, and even published in Dr. Stephen Wangen’s book “Healthier Without Wheat.” Once you’ve have positive blood testing for celiac disease, the biopsy is superfluous. But not for the doctor, because that is how they make their living.
Patients with positive blood tests for celiac may not be “confirmed” by positive biopsy because the mucosal damage has not yet occurred. But the symptoms may still be present and may come and go despite remaining on a gluten containing diet. For these patients the best way to maintain and improve health is to cut out gluten (though that is not reported in this paper).
Prevalence and natural history of potential celiac disease in adult patients.
Potential celiac disease (PCD) is a form of CD characterized by positive endomysial/tissue transglutaminase antibodies and a preserved duodenal mucosa despite a gluten-containing diet (GCD); it can evolve into flat, active CD. This evolution is, however, not certain. Our aim was to retrospectively study the prevalence and the natural history of adult patients with PCD.
The clinical notes of all 47 patients with PCD attending our clinic between September 1999 and October 2011 were retrospectively reevaluated. To study their clinical features, patients with active CD, randomly selected and matched for sex and date of birth, served as controls. Symptoms, associated diseases, familiarity, and laboratory data at diagnosis were compared.
Prevalence of PCD among all celiac patients directly diagnosed in our center was 42/187, (1/4.4, 18.3%, 95% confidence interval (CI) 13.3-23.4%). Age at diagnosis, laboratory data, prevalence of symptoms, associated diseases, and familiarity for CD did not differ between patients with PCD and those with active CD. Some patients with PCD maintained a normal duodenal mucosa for many years and their symptoms spontaneously improved despite maintaining a GCD.
PCD is not a rare form of CD. Having found no difference at all in age at diagnosis and clinical features between PCD and active CD could suggest that PCD is not a prodrome of CD but is a separate entity that can only subsequently evolve into active CD.
Biagi F, Trotta L, Alfano C, Balduzzi D, Staffieri V, Bianchi PI, Marchese A, Vattiato C, Zilli A, Luinetti O, Gobbi P, Corazza GR.
Coeliac Centre/First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy. firstname.lastname@example.org