Five year time course of celiac disease serology during gluten free diet: results of a community based " CD-Watch" program.

Background. Little information is available on the effect of a follow-up strategy in celiac disease (CD) patients during gluten free diet (GFD). Aims. To assess 5 years time course of t-transglutaminases antibodies (t-TG) in CD patients enrolled in a community based follow-up program. Methods. Annual t-TG testing and periodical clinic visit in 2245 patients. Results. Proportion of patients with negative t-TG progressively increased from 83% to 93% during the 5 years follow-up: poor adherence to GFD (HR 4.764), long duration of GFD (HR 0.929) and female gender (HR 1.472) were independently associated with serological outcome. In individual patients, 69% tested t-TG “persistently-negative”, 1% “persistently positive” and 30% “intermittently negative or positive”. By applying mathematical modelling to t-TG conversion rates observed in this latter group at beginning and end of the follow-up program, the predicted proportion of t-TG negative population increased from 90% to 95% during the 5 years implementation of the program. Conclusions. Time-course of t-TG serology in the community fluctuates in 1/3 of CD patients suggesting inconstant adherence to GFD and need of follow-up strategy. Periodical serological and clinical follow-up is a viable and efficacious strategy to promote adherence to GFD as inferred from time-course of t-TG serology.