Whether a life-long gluten-free diet is necessary in all children with diagnosed celiac disease remains debated.
Dr Tamara Matysiak-Budnik and colleagues from France conducted a retrospective analysis of the clinical and biological status of adult celiac patients diagnosed in childhood.
The patients remained on a normal diet after gluten challenge and were clinically silent.
The team assessed patients aged 18 to 65 years with celiac disease diagnosed in childhood.
|Osteoporosis occurred in 11% with latent celiac disease vs 70% with silent celiac disease|
Clinical status, gluten intake, biological parameters of malabsorption, bone mineral density, and human leucocyte antigen genotype were recorded.
Serological markers of coeliac disease, and histological and immunohistochemical parameters in duodenal biopsies were also recorded.
The researchers found that 61 patients had resumed a normal diet and were asymptomatic.
The team noted that 48 patients showed different degrees of villous atrophy, while 13 had no detectable atrophy on duodenal biopsies.
Latent celiac disease patients had significantly less osteopenia/osteoporosis, occurring in 11% vs 70% in silent celiac disease patients.
The team observed lower T cell receptor ß+ intraepithelial T cell counts in latent celiac disease patients than silent coeliac disease patients.
The team found the mean age at diagnosis and first gluten-free diet was lower in latent than in silent patients.
The researchers found latent patients did not differ significantly from the 7 control patients on a long-term gluten-free diet.
However, latent patients had a higher frequency of celiac disease-specific serum antibodies.
The team noted that 2 latent patients relapsed clinically and histologically during subsequent follow-up.
Dr Matysiak-Budnik's team concluded, "Long-term latency developed in about 20% of celiac disease patients who remained symptom free after gluten reintroduction."
"This latency can be transient and thus a regular follow-up is mandatory."
"In silent patients, the increased risk of osteoporosis substantiates the need for a gluten-free diet."