Wait-and-See Approach or Gluten-Free Diet Administration—The Rational Management of Potential Coeliac Disease

Abstract

Potential celiac disease (PCD) is a heterogeneous disease; only some patients develop full celiac disease (CD), characterised by advanced atrophic changes in the small intestine. Few accurate prognostic factors exist for the progression of PCD; therefore, therapeutic decisions should be made on an individual basis in each case. Patients with clinical gastroenterological or parenteral symptoms often benefit from a gluten-free diet, and those left on a diet containing gluten should receive clinical, serological and histopathological supervision.

Review article: Becoming and being coeliac—special considerations for childhood, adolescence and beyond

“…however, IELs may persist. 109 Conversely, symptomatic PCD patients who continue to eat gluten are more likely to remain symptomatic and seropositive, and to have histologic progression. 76,78 The GFD is not a benign intervention; it significantly impacts quality of life and carries considerable challenges, social and financial burdens and potential nutritional risks.…”

“…The GFD is not a benign intervention; it significantly impacts quality of life and carries considerable challenges, social and financial burdens and potential nutritional risks. Therefore, care must be taken to avoid overtreating PCD patients who may not benefit 109 . This is particularly a concern for asymptomatic PCD patients for whom continuing to eat gluten with close monitoring may be most appropriate.…”

“…Therefore, care must be taken to avoid overtreating PCD patients who may not benefit. 109 This is particularly a concern for asymptomatic PCD patients for whom continuing to eat gluten with close monitoring may be most appropriate. Otherwise, it may be unclear whether reversion to seronegative is spontaneous or related to gluten withdrawal.…”

“…Although it appears that the vast majority will not develop CD, our knowledge of the natural history of PCD is limited by the significant minority, particularly those who are symptomatic, who adopt a GFD pre‐emptively. Most symptomatic PCD patients who initiate a GFD have a clinical benefit and serologic response; however, IELs may persist 109 . Conversely, symptomatic PCD patients who continue to eat gluten are more likely to remain symptomatic and seropositive , and to have histologic progression 76,78 …”