Ida Gustafsson1, Marleena Repo1, Alina Popp2, Katri Kaukinen3, Pauliina Hiltunen1, Taina Arvola4, Juha Taavela5, Martine Vornanen6, Laura Kivelä7, Kalle Kurppa8. 1. Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University and Department of Pediatrics, Tampere University Hospital, Tampere, Finland. 2. Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University and Department of Pediatrics, Tampere University Hospital, Tampere, Finland; Carol Davila University of Medicine and Pharmacy, National Institute for Mother and Child Health, Bucharest, Romania. 3. Department of Internal Medicine, Tampere University Hospital and Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. 4. Hämeenlinna Central Hospital, Hämeenlinna, Finland and Allergy Centre, Tampere University Hospital, Tampere, Finland. 5. Central Finland Central Hospital, Jyväskylä, Finland. 6. Department of Pathology, Tampere University Hospital, Tampere, Finland. 7. Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University and Department of Pediatrics, Tampere University Hospital, Tampere, Finland; University of Helsinki and Helsinki University Hospital, Children's Hospital, and Pediatric Research Center, Helsinki, Finland. 8. Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University and Department of Pediatrics, Tampere University Hospital, Tampere, Finland; The University Consortium of Seinäjoki, Seinäjoki, Finland. Electronic address: kalle.kurppa@uta.fi.
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.
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 diseasepatients, 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.