Abstract
Background
Celiac disease diagnostics begin by measuring autoantibodies, which may fail to identify
seronegative patients. Duodenal lesion in the absence of antibodies is scarcely studied,
especially in children.
Aims
To investigate the prevalence and diagnostic outcomes of children with seronegative
duodenal lesion in two countries with different disease profiles.
Methods
Medical data, including the results of histology and transglutaminase (tTGab) and
endomysium (EmA) antibody measurements were collected from 1172 Finnish and 264 Romanian
children with systematic duodenal sampling. Database of 509 Finnish children with
celiac disease was examined to identify earlier seronegative patients.
Results
Celiac disease was diagnosed in 307 Finnish and 83 Romanian children in the endoscopy
cohorts. No seronegative patients were found among 899 celiac disease patients, although
some were only tTGab or EmA positive. Non-celiac duodenal lesion was detected in eight
Finnish and 32 Romanian children, their most common diagnoses being inflammatory bowel
disease and infections, respectively. Six children with morphological lesion received
no diagnosis. None of them developed celiac disease during a follow-up of 3–11 years.
Conclusion
Pediatric seronegative celiac disease is exceptional in the era of modern autoantibodies.
Other reasons for duodenal lesion should therefore be sought, bearing in mind possible
differences across countries.
Abbreviations:
AIE (autoimmune enteropathy), ARA (antireticulin antibody), EGD (esophagogastroduodenoscopy), EmA (endomysium antibody), HLA (human leucocyte antigen), IBD (inflammatory bowel disease), IEL (intraepithelial lymphocyte), PVA (partial villous atrophy), SVA (subtotal villous atrophy), tTGab (tissue transglutaminase antibody), TVA (total villous atrophy)Keywords
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Article info
Publication history
Published online: December 30, 2019
Accepted:
November 19,
2019
Received:
October 21,
2019
Footnotes
⋆Prospective part of this study is registered at clinicaltrials.gov; trial identifying number NCT02072590.
Identification
Copyright
© 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
