Coeliac disease and non-adherence to the diet?

Almost 15- years old boy Antonín was diagnosed with celiac disease (CD) in May 2015 – non biopsy approach included at that time HLA testing. He started with gluten-free diet from July 2015.

Originally, he was referred for consultation at paediatric gastroenterologist because abdominal pain and family history of CD. His sister Klara was diagnosed with CD (non-biopsy) in 2014 in the age of 3 years at our gastroenterology department.

Practically both siblings never reached sero-negativity, mother was repeatedly teached and educated on gluten free diet. Both parents proclaimed strict gluten free diet at home and in the school, excluding any possible contamination.

Last sibling – the youngest sister does not have CD and she is on a normal diet.

Because of seropositivity, in June 2022 we decided to perform endoscopies in Antonin, and histology from duodenum biopsies showed Marsh-Oberhuber IIIa. The endoscopy and histology in his sister Klara (September 2022) were negative. Consequently, her serology was finally negative since August 2022.

In addition, we analysed GIP (Gluten Immunogenic Peptides) in the stool of all 3 siblings.

In the case of Antonin were GIP highly positive, in Klara´s stool were negative but surprisingly in last sister, who does not follow gluten free diet, were negative!

Mother refuse any intentional or possible mistake in the diet, analysis of the diet from dietary record given by parents was performed in our celiac consultation office led by experienced person, without any gluten containing products.

We do plan repeat stool analysis for GIPs in all children and we do consider separate consultation of Antonin with high suspicion on noncompliance.