Persistent antibody positivity and gastrointestinal symptoms predicted progression of potential celiac disease to celiac disease

Background: The natural history of potential celiac disease is poorly defined. Aims: To study factors predicting progression of potential celiac disease to overt celiac disease. Methods: Medical data were collected from patients with potential celiac disease defined as positive tissue transglutaminase and/or endomysial autoantibodies without diagnostic duodenal villous atrophy. Results: Of 158 patients with potential celiac disease (61 % women, median age 16 years, range 1-81 years), follow-up data were available for 128. The median follow-up time in patients not receiving a diagnosis was 14.6 years, and the median time until celiac disease diagnosis was 2.1 years. Serology normalized spontaneously in 38 %, while 61 % remained seropositive and 2 % began a gluten-free diet. Seventy-three patients underwent repeat endoscopy and 63 % of them received a celiac disease diagnosis. Those with later celiac disease diagnosis reported symptoms more often (84 % vs. 62 % p = 0.020) and were less frequently screen-detected (23 % vs. 52 %, p = 0.004) at their first endoscopy. During follow-up, they experienced persistent gastrointestinal symptoms more often (54 % vs. 27 %, p = 0.006) and remained seropositive (50 % vs. 16 %, p = 0.018). Conclusion: During long-term follow-up, 63 % of the patients undergoing repeat endoscopy developed celiac disease. Predictive factors included baseline symptoms and persistence of gastrointestinal symptoms and sustained seropositivity.