ArticleAlimentary pharmacology & therapeutics2021
Clinical classification and long-term outcomes of seronegative coeliac disease: a 20-year multicentre follow-up study.
Article in Alimentary pharmacology & therapeutics, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 37 citations in OpenAlex.
- European Society for the Study of Coeliac Disease 2025 Updated Guidelines on the Diagnosis and Management of Coeliac Disease in Adults. Part 1: Diagnostic Approach.United European gastroenterology journal · 2025Guideline
- Presence of alarm symptoms at coeliac disease diagnosis is not associated with poorer long-term treatment outcomes.European journal of gastroenterology & hepatology · 2026Article
- Unraveling the Complexity of Celiac Disease: A Narrative Review of Its Multisystem Nature.Medicina (Kaunas, Lithuania) · 2026Review
- The hidden link between iron deficiency and celiac disease: a clinical perspective.Frontiers in immunology · 2026Article
- Management Strategy for Non-Responsive and Refractory Celiac Disease in Adults: A Review Article.Journal of clinical medicine · 2025Review
- Nationwide survey of coeliac disease serology testing in the UK.BMJ open gastroenterology · 2025Article
- Evaluation of the Frequency of HLA-DQ2/DQ8 Genes Among Patients with Celiac Disease and Those on a Gluten-Free Diet.Foods (Basel, Switzerland) · 2025Article
- A small bowel adenocarcinoma harboring a DDR2 mutation in a celiac patient.Clinical journal of gastroenterology · 2024Article
- Article
- The Gluten-Free Diet for Celiac Disease: Critical Insights to Better Understand Clinical Outcomes.Nutrients · 2023Review
- Article
- Non-Responsive and Refractory Coeliac Disease: Experience from the NHS England National Centre.Nutrients · 2022Article
- Review
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Authors and funding
15 authors at 6 institutions in 3 countries.
Funding
Abstract
backgroundSeronegative coeliac disease is poorly defined.
aimsTo study clinical phenotypes and long-term outcomes of seronegative coeliac disease in a multicentre cohort over 20 years.
methodsSeronegative coeliac disease was diagnosed in HLA-DQ2/DQ8-positive patients with villous atrophy (VA), negative IgA endomysial (EmA), tissue transglutaminase (tTG) and deamidated-gliadin antibodies (DGP), clinical and histological response to a gluten-free diet (GFD), and no alternative causes for VA. In patients with IgA deficiency, coeliac disease was diagnosed through VA, positive IgG EmA/tTG/DGP and clinical/histological response to a GFD (coeliac disease+IgAd). Patients with seropositive coeliac disease served as controls.
resultsOf 227 patients previously diagnosed with seronegative coeliac disease, true seronegative coeliac disease was confirmed in 84, coeliac disease+IgAd in 48, and excluded in 55. Lack of follow-up duodenal biopsy precluded diagnosing seronegative coeliac disease in 40 patients. 2084 patients with seropositive coeliac disease served as controls. True seronegative coeliac disease had more severe symptoms at diagnosis and a higher risk of complications (HR 10.87, 95% CI 6.11-19.33, P < 0.001) and mortality (HR 2.18, 95% CI 1.12-4.26, P < 0.01) than seropositive coeliac disease. There were no differences between true seronegative coeliac disease and coeliac disease+IgAd. On multivariate analysis, age at diagnosis, lack of clinical response to a GFD, true seronegative coeliac disease, coeliac disease+IgAd, and classical presentation predicted complications. Age at diagnosis, complications and absence of clinical response to a GFD predicted mortality.
conclusionsSeronegative coeliac disease has a more aggressive disease phenotype than seropositive coeliac disease. These data argue against over-reliance on serology for the diagnosis of coeliac disease and support a strict clinical and histologic follow-up in seronegative coeliac disease.
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