This is the first study demonstrating that children with CD may have patchy villous atrophy of the duodenum. The bulb mucosa may be the only duodenal area involved, both at diagnosis and after gluten challenge. Therefore, multiple endoscopic biopsies should always be performed, not only in the distal duodenum, but also in the bulb.

On the basis of a carefully conducted study, CD prevalence in our series was seen as very high. These data suggest an accurate algorithm to select candidates for intestinal biopsy among CD high-risk subjects. First, an evaluation of the sensitive RIA TGAA and of total IgA (in IgA deficiency RIA IgG anti-tissue transglutaminase assay) should be performed. Then, an evaluation of the TGAA and the genetic study would be advisable 2 to 3 years later in negative subjects. Those carrying the DQ2/DQ8 heterodimers should continue the serologic follow-up; the others need a clinical follow-up.

Objective To test the possibility of detecting tissue transglutaminase autoantibodies (tTG-Abs) in saliva with a novel sensitive fluid-phase radioimmunoassay (RIA).Study design Paired saliva and serum samples from 39 patients with celiac disease (CD), at the first biopsy (Group 1: 28 females, mean age 11.5 ± 11.1 years); 32 controls with a normal duodenal mucosa (Group 2: 18 females, mean age 8.1 ± 3.6 years); and 32 healthy volunteers (Group 3: 21 females, mean age 31.7 ± 9.8 years) were studied for tTG-Ab presence. Limit of positivity for salivary assay was calculated according to the 99th percentiles of Group 2 control children and was expressed as an autoantibody (Ab) index.Results Salivary tTG-Abs were found in 97.4% of the patients with CD and in 100% of the corresponding serum samples. All Group 3 subjects were negative with both saliva and serum assays. A correlation between saliva and serum tTG-Ab titers was found (r = 0.826, P = .0014).Conclusions This study demonstrates that it is possible to detect salivary tTG-Abs in CD with a non-invasive, simple to perform, reproducible and sensitive method. (J Pediatr 2004;144:632-6) C eliac disease (CD) may appear in a classic presentation, with gastrointestinal complaints and growth failure or with extraintestinal manifestations and ''atypical forms'' 1 characterized by anemia and short stature, 2,3 or with a silent form, more frequent in first-degree relatives of patients with CD. 4 The prevalence of CD is increased in subjects with elevated aminotransferase levels, 5,6 autoimmune diseases, 7,8 and chromosomal aberrations. 9,10 Complications of long-standing CD may include osteopathy, 11 endocrinopathy, 12 infertility, low birth weight infants, 13,14 cancer, 15 and dilated cardiomyopathy and other forms of heart failure. 16 CD has a high prevalence in the general population (0.55% in Italy), often in an asymptomatic form. 17 To reduce the risks associated with prolonged gluten exposure, CD should be diagnosed early, on the basis of the result of one or more intestinal biopsies. 18 Patients with CD receiving a gluten-containing diet have increased levels of anti-gliadin (AGA), anti-endomysium (EMA), 19 and anti-tissue transglutaminase autoantibodies (anti-tTG-Ab). 20 Serum AGA have proved to be effective in the identification of children at risk for CD, but less so in adult screening. 21 EMA are more specific than AGA but are observer-dependent, and sometimes they are not found in children with CD younger than aged 2 years. 19 The recent identification of tTG as the main autoantigen recognized by EMA 22 has lead to the development of various studies that suggest an important role for this enzyme in the etiopathogenesis of CD. 23,24 Several methods have been proposed for the detection of humoral anti-tTG immunoreactivity in CD. 20,[25][26][27] The most sensitive assays to detect tTG-Abs were those using human recombinant tTG in a fluid-phase radioimmunoassay (RIA) format. 26,27 Attempts have been made in assaying CD-related Ab in saliva, [28][29][30][31][32][...

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Our aim was to evaluate body composition in a group of coeliac disease adolescents on a gluten-free diet and to re-examine them at the end of the adolescence spurt. We studied 48 patients (group 1A), 30 age-matched healthy controls (group 2A), 11 group 1A patients after 4 years (group 1B) and 11 adolescents who were age- and sex-matched with group 1B (group 2B). Weight, height, bone mineral content, fat mass, fat-free mass (FFM) and bone mineral density were evaluated using dual-energy X-ray absorptiometry. All parameters were lower in group 1A than in group 2A subjects ( p<0.001). After 4 years, the body compartments of group 1B coeliac disease patients normalised, except for weight and FFM which remained lower than in group 2B subjects ( p<0.005). In conclusion, our study demonstrates that adolescence is a period where some parameters of body composition can still be recovered.