Celiac Disease Prevention

Study Overview
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Brief Summary
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Celiac disease is an autoimmune disease induced by wheat gluten. Destruction of epithelial cells and microvilli on gut mucosa is causing a flat mucosa and an absorption defect. The diagnosis is based on typical microscopical finding in biopsy specimens but serum antibodies to tissue transglutaminase and certain gliadin peptides are strongly associated with the pathology. Severe diarrhoea associated with growth disturbance in infancy was historically characterising the disease but is nowadays rare. Clinically more mild forms including silent disease are very common. Studies based on antibody screening and biopsies done in autoantibody positive subjects have confirmed a frequency of about 1-2% in adult population. Undiagnosed disease is associated with deficiencies of nutrients and vitamins leading to various chronic symptoms like anaemia, osteoporosis and general fatigue. It has also been recently found that undiagnosed celiac disease may be associated with general underachievement in society probably associated with common psychological symptoms like fatigue and depression during the adolescence. The disease is treated by complete elimination of wheat, rye and barley in the diet, which is laborious and causing considerable extra costs in nutrition. Much progress has been recently made in understanding of the genetic background and immune markers associated with the disease as well as in understanding those patterns of gluten introduction in infancy, which might be connected to a high disease risk. Our aim in this study is in the first phase to identify children at high genetic risk (around 10%) and in a follow-up study to define: Are the age, dose of gluten and presence of simultaneous breast feeding at the introduction of gluten associated with the risk of celiac disease? Is it possible to decrease the frequency of celiac disease by nutritional counselling? Is it possible to predict development of celiac disease by immunological tests before the development of mucosal lesion If we can confirm, that optimising the conditions at the introduction of wheat gluten in infancy diet significantly reduces the disease incidence, will this have an important effect on the nutritional recommendations concerning the diet in infancy. Combining genetic screening and immunological tests might also offer a way to reduce the frequency of celiac disease and help in early diagnosis and organisation of an adequate treatment

Official Title
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Prevention of Celiac Disease in Children at Genetic Risk - Optimized Introduction of Gluten and Follow-up of Immunization

Conditions
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Celiac Disease

Intervention / Treatment
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* Other: Optimal gluten introduction


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Presence of HLA-risk alleles DQA1*05 and DQB1*02 Exclusion Criteria: Lack of these HLA risk alleles

Ages Eligible for Study
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Maximum Age: 2 Months

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: 1<br>Optimization of gluten introduction by nutritional councelling | Other: Optimal gluten introduction<br>* Optimization of gluten introduction by nutritional counselling<br>|
| No Intervention: 2<br>No specific nutritional councelling. Follow-up of gluten introduction | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| development of transglutaminase antibodies |  | 2-4 year age | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| gliadin peptide antibodies |  | 2-4 years | 
| mucosal biopsy in TGA positive childre |  | 2-4 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Celiac disease, genetic risk, gluten introduction, predicting antibodies