Clinical outcomes of potential coeliac disease (PCD)
Shiha MG et al, Gut. 2024;73(12):1944-1952
Almost a third of patients with PCD with ongoing gluten-containing diet develop villous atrophy over time, whereas a similar proportion experience normalisation of serology. However, most symptomatic PCD patients benefit from a gluten-free diet.
Objective: 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, the authors aimed to evaluate the clinical outcomes of patients with PCD.
Design: They 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% confidence intervals (CIs).
Results: 17 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: 10–22%). 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: 18–48%; I2 = 96.4%) of patients with PCD on a gluten-containing diet developed villous atrophy, and 33% (95% CI: 17–48%; I2 = 93.0%) had normalisation of serology. Among those who adhered to a GFD, 88% (95% CI: 79–97%; I2 = 93.2%) reported symptomatic improvement.
Conclusion: Almost a third of patients with potential coeliac disease (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 gluten-free diet. These findings highlight the importance of structured follow-up and individualised management for patients with PCD.