Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
Division of Clinical Medicine, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK.
Gut. 2024 Nov 11;73(12):1944-1952. doi: 10.1136/gutjnl-2024-333110.
Potential coeliac disease (PCD) is characterised by positive serological and genetic markers of coeliac disease with architecturally preserved duodenal mucosa. The clinical outcomes and rates of progression to overt coeliac disease in patients with PCD remain uncertain. In this systematic review and meta-analysis, we aimed to evaluate the clinical outcomes of patients with PCD.
We searched Medline, Embase, Scopus and Cochrane Library from 1991 through May 2024 to identify studies evaluating the clinical outcomes of patients with PCD. The progression rates to villous atrophy, seroconversion and response to a gluten-free diet (GFD) were analysed. A random-effect meta-analysis was performed, and the results were reported as pooled proportions with 95% CIs.
Seventeen studies comprising 1010 patients with PCD were included in the final analyses. The pooled prevalence of PCD among patients with suspected coeliac disease was 16% (95% CI 10% to 22%). The duration of follow-up in most of the studies was at least 1 year, with follow-up periods within individual studies ranging from 5 months to 13 years. During follow-up, 33% (95% CI 18% to 48%; I=96.4%) of patients with PCD on a gluten-containing diet developed villous atrophy, and 33% (95% CI 17% to 48%; I=93.0%) had normalisation of serology. Among those who adhered to a GFD, 88% (95% CI 79% to 97%; I=93.2%) reported symptomatic improvement.
Almost a third of patients with PCD develop villous atrophy over time, whereas a similar proportion experience normalisation of serology despite a gluten-containing diet. Most symptomatic patients benefit from a GFD. These findings highlight the importance of structured follow-up and individualised management for patients with PCD.
潜在的乳糜泻（PCD）的特征是乳糜泻的血清学和遗传标志物阳性，而十二指肠黏膜的结构保持完整。患有 PCD 的患者的临床结局和发展为显性乳糜泻的比例仍不确定。在这项系统评价和荟萃分析中，我们旨在评估 PCD 患者的临床结局。
我们检索了 Medline、Embase、Scopus 和 Cochrane Library，从 1991 年到 2024 年 5 月，以确定评估 PCD 患者临床结局的研究。分析了向绒毛萎缩、血清学转换和对无麸质饮食（GFD）反应的进展率。进行了随机效应荟萃分析，并以 95%置信区间（CI）的汇总比例报告结果。
最终分析纳入了 17 项研究，共 1010 例 PCD 患者。在疑似乳糜泻患者中，PCD 的总患病率为 16%（95%CI 10%至 22%）。大多数研究的随访时间至少为 1 年，个别研究的随访期从 5 个月到 13 年不等。在随访期间，33%（95%CI 18%至 48%；I=96.4%）的 PCD 患者在食用含麸质饮食后出现绒毛萎缩，33%（95%CI 17%至 48%；I=93.0%）的患者血清学恢复正常。在那些坚持 GFD 的患者中，88%（95%CI 79%至 97%；I=93.2%）报告症状改善。
随着时间的推移，几乎三分之一的 PCD 患者会出现绒毛萎缩，而尽管食用含麸质饮食，相似比例的患者血清学恢复正常。大多数有症状的患者受益于 GFD。这些发现强调了对 PCD 患者进行结构化随访和个体化管理的重要性。
