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BMC Gastroenterology
Published in: BMC Gastroenterology 1/2009

Open Access 01-12-2009 | Research article

Symptoms and signs in individuals with serology positive for celiac disease but normal mucosa

Authors: Jonas F Ludvigsson, Lena Brandt, Scott M Montgomery

Published in: BMC Gastroenterology | Issue 1/2009

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Abstract

Background

Antibody serology is an important tool in the investigation of celiac disease (CD), but does not always correlate with mucosal appearance in the small intestine. Patients with positive CD serology but normal mucosa (Marsh 0) are at increased risk of future CD. In this study we describe a model for identifying and characterizing individuals with normal mucosa but positive CD serology. Such individuals are sometimes referred to as having latent CD.

Methods

The records of ten Swedish pathology departments were used to identify individuals with biopsies indicating normal duodenal/jejunal mucosa. Using the national personal identification number, these data were linked with CD serology data (antigliadin, antiendomysial and tissue transglutaminase antibodies); and we thereby identified 3,736 individuals with normal mucosa but positive CD serology. Two independent reviewers then manually reviewed their biopsy reports to estimate comorbidity. We also randomly selected 112 individuals for validation through patient chart review.

Results

The majority of the 3,736 individuals were females (62%). Children (0–15 years) made up 21.4%. The median number of biopsy specimen was 3. Our review of biopsy reports found that other gastrointestinal comorbidity was rare (inflammatory bowel disease: 0.4%; helicobacter pylori infection: 0.2%). Some 22% individuals selected for patient chart review had a relative with CD. The most common symptoms among these individuals were diarrhea (46%) and abdominal pain (45%), while 26% had anemia. Although 27% of the individuals selected for validation had been informed about gluten-free diet, only 13% were adhering to a gluten-free diet at the end of follow-up.

Conclusion

Individuals with positive CD serology but normal mucosa often have CD-like symptoms and a family history of CD.
Appendix
Available only for authorised users
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Metadata
Title
Symptoms and signs in individuals with serology positive for celiac disease but normal mucosa
Authors
Jonas F Ludvigsson
Lena Brandt
Scott M Montgomery
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Gastroenterology / Issue 1/2009
Electronic ISSN: 1471-230X
DOI
https://doi.org/10.1186/1471-230X-9-57

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