Celiac disease antibody levels reflect duodenal mucosal damage but not clinical symptoms.

OBJECTIVES

This study aimed to investigate, in a real-world population, whether the histological and clinical phenotype differ at baseline and during follow-up in patients with high and low CD (celiac disease) antibody titers.

MATERIALS AND METHODS

The study cohort consisted of 96 consecutive patients diagnosed to have CD during the years 2010-2018. The clinical parameters, symptoms and laboratory results were registered and histomorphometry was analyzed from the available duodenal biopsies taken during the primary and follow-up esophageal-gastricduodenoscopies. Patients having immunoglobulin A transglutaminase antibody (tTG-ab) levels above 70 U/mL were classified as high titer patients.

RESULTS

Measured by the villous-crypt ratio, the duodenal mucosa was more severely damaged in the high tTG-ab group than in the low tTG-group at baseline ( = 70, 0.61 ± 0.63 vs. 1.02 ± 0.87,  = .003) and during the follow-up when the patients were on gluten-free diet ( = 27, 1.80 ± 0.72 vs. 2.35 ± 0.64,  = .041). Interestingly, the high tTG-ab group members had fewer gastrointestinal symptoms at baseline than those in the low tTG-ab group (43% vs. 68%,  = .013) but lower vitamin D levels (68 ± 34 nmol/L vs. 88 ± 29 nmol/L,  = .034) and more often microcytosis (28% vs. 10%,  = .040). During the follow-up, these differences were no longer detected.

CONCLUSIONS

At baseline, CD patients with high tTG-ab have more severe duodenum injury and signs of malabsorption but fewer symptoms. After gluten-free diet has been initiated, the mucosal healing in the high tTG-ab group is prolonged, but symptoms and signs of malabsorption recover equally in both groups.