Post by kickingfrog on Jan 31, 2011 16:14:21 GMT
Celiac Disease without Villous Atrophy in Children: A Prospective Study
Kalle Kurppa, MDa, Merja Ashorn, MD, PhDa, Sari Iltanen, MD, PhDa, Lotta L.E. Koskinen, PhDb, Päivi Saavalainen, PhDb, Outi Koskinen, MDa, Markku Mäki, MD, PhDa, Katri Kaukinen, MD, PhDc
Received 9 December 2009; received in revised form 8 February 2010; accepted 26 February 2010. published online 19 April 2010.
Corrected Proof
Objective
To establish whether children who are endomysial antibody (EmA) positive and have normal small-bowel mucosal villous morphology are truly gluten-sensitive and may benefit from early treatment with a gluten-free diet.
Study design
Children who were EmA positive with normal small-bowel mucosal villi were compared with children who were seropositive with villous atrophy by using several markers of untreated celiac disease. Thereafter, children with normal villous structure either continued on a normal diet or were placed on a gluten-free diet and re-investigated after 1 year. Seventeen children who were seronegative served as control subjects for baseline investigations.
Results
Normal villous morphology was noted in 17 children who were EmA positive, and villous atrophy was noted in 42 children who were EmA positive. These children were comparable in all measured variables regardless of the degree of enteropathy, but differed significantly from the seronegative control subjects. During the dietary intervention, in children who were EmA positive with normal villi, the disease was exacerbated in children who continued gluten consumption, whereas in all children who started the gluten-free diet, both the gastrointestinal symptoms and abnormal antibodies disappeared.
Conclusions
The study provided evidence that children who are EmA positive have a celiac-type disorder and benefit from early treatment despite normal mucosal structure, indicating that the diagnostic criteria for celiac disease should be re-evaluated.
Kalle Kurppa, MDa, Merja Ashorn, MD, PhDa, Sari Iltanen, MD, PhDa, Lotta L.E. Koskinen, PhDb, Päivi Saavalainen, PhDb, Outi Koskinen, MDa, Markku Mäki, MD, PhDa, Katri Kaukinen, MD, PhDc
Received 9 December 2009; received in revised form 8 February 2010; accepted 26 February 2010. published online 19 April 2010.
Corrected Proof
Objective
To establish whether children who are endomysial antibody (EmA) positive and have normal small-bowel mucosal villous morphology are truly gluten-sensitive and may benefit from early treatment with a gluten-free diet.
Study design
Children who were EmA positive with normal small-bowel mucosal villi were compared with children who were seropositive with villous atrophy by using several markers of untreated celiac disease. Thereafter, children with normal villous structure either continued on a normal diet or were placed on a gluten-free diet and re-investigated after 1 year. Seventeen children who were seronegative served as control subjects for baseline investigations.
Results
Normal villous morphology was noted in 17 children who were EmA positive, and villous atrophy was noted in 42 children who were EmA positive. These children were comparable in all measured variables regardless of the degree of enteropathy, but differed significantly from the seronegative control subjects. During the dietary intervention, in children who were EmA positive with normal villi, the disease was exacerbated in children who continued gluten consumption, whereas in all children who started the gluten-free diet, both the gastrointestinal symptoms and abnormal antibodies disappeared.
Conclusions
The study provided evidence that children who are EmA positive have a celiac-type disorder and benefit from early treatment despite normal mucosal structure, indicating that the diagnostic criteria for celiac disease should be re-evaluated.