Persistent symptoms in treated celiac disease (CD) are common and are supposedly due to infractions to a gluten-free diet (GFD) or complications.

The present study investigated the etiology and natural history of clinically relevant events (CREs) throughout follow-up and identified predictors to guide follow-up.

It retrospectively collected CREs (symptoms/signs requiring diagnostic/therapeutic interventions) occurring in celiac patients.

The study observed-

• Enrollment of one-hundred-and-eighty-nine adult patients (133 F, age at diagnosis 36 ± 13 years, median follow-up 103 months). 
• Frequent occurrence of CREs (47%), but hardly due to poor GFD adherence (4%) or complications (2%).
• Leading etiologies were functional gastrointestinal disorders (30%), reflux disease (18%), and micronutrient deficiencies (10%). 
• Age at diagnosis ≥ 45 years and classical pattern of CD were predictors of CREs on a multivariable Cox model. 
• At five years, 46% of classical patients ≥ 45 years old at diagnosis were event-free, while it remained 62% for non-classical/silent ≥ 45 years, 60% for classical < 45 years, and 80% for non-classical/silent < 45 years.

This study shows the occurrence of CREs in almost half of the CD patients during follow-up, with functional disorders being the most common. New follow-up strategies for adult CD based on age and clinical pattern at diagnosis are warranted.

Schiepatti A, Maimaris S, Lusetti F., et al. High Prevalence of Functional Gastrointestinal Disorders in Celiac Patients with Persistent Symptoms on a Gluten-Free Diet: A 20-Year Follow-Up Study. Dig Dis Sci. 2022. https://doi.org/10.1007/s10620-022-07727-x