This observational retrospective study describes the rate and time of symptom resolution in celiac disease (CD) in a cohort of pediatric patients following a gluten-free diet (GFD). We evaluated the rate and time to symptom resolution after starting a GFD, as well as associated predictive factors (age, gender, comorbidities, familial history, IgA anti-transglutaminase antibodies (TGA-IgA) at diagnosis, dietary adherence), in children diagnosed with CD between 2014 and 2022 at the Gastroenterology Unit of Maggiore Hospital, Bologna. The minimum follow-up period was 6 months. Of 421 symptomatic patients at diagnosis, 77.4% presented gastrointestinal symptoms (GIs) (40.6% recurrent abdominal pain, 19.5% diarrhea, 21.6% constipation, 17.3% bloating), 47.5% extra-intestinal symptoms (EISs) (16.4% neurological symptoms, 9.0% anemia), and 33.5% growth retardation (31.6% failure to thrive, 17.8% short stature). 96.7% had a high GFD adherence through follow-up. The overall symptom resolution rate was 84.8% (GIs 89.0%, EISs 92.6%, growth retardation 87.4%). Constipation had a significantly lower resolution rate compared to other GIs (p = 0.02) or diarrhea (p = 0.03). In total, 81.7% of patients achieved symptom resolution within 12 months. Short stature and anemia resolved more slowly compared to other symptoms. TGA-IgA normalization and GFD adherence were significant predictors of symptom resolution.Conclusion: Most symptoms resolved within the first year of diagnosis. The lower resolution rate for constipation compared to other GIs suggests a functional etiology, while the delayed recovery of anemia and short stature likely reflects their complex etiology. Serological normalization and GFD adherence are confirmed as predictors of clinical remission. <Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry nameend="c2" namest="c1"> What is Known: • Time to clinical remission in celiac children after starting a gluten-free diet may vary between different symptoms. • Clinical remission is associated with serological normalization and adherence to diet. </entry> </row> <row> <entry nameend="c2" namest="c1"> What is New: • Constipation has a significantly poorer rate of resolution among other gastrointestinal symptoms, due to its functional etiology, while anemia and short stature resolve slightly slower. • Most patients reach clinical remission within the first year on a gluten-free diet; serological normalization and diet adherence are confirmed to be predictors of clinical remission. </entry> </row> </tbody> </tgroup> </Table>

Rate and timing to clinical remission in celiac children on a gluten-free diet

期刊论文
发表日期：

2026年5月8日

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Francesca Sbravati,
Carolina Arsani,
Davide Gori,
Beatrice De Palo,
Irene Frigo,
Chiara Del Bono,
Sara Brintazzoli,
Gilda Barbieri,
Flavio Labriola,
Patrizia Alvisi

摘要

This observational retrospective study describes the rate and time of symptom resolution in celiac disease (CD) in a cohort of pediatric patients following a gluten-free diet (GFD). We evaluated the rate and time to symptom resolution after starting a GFD, as well as associated predictive factors (age, gender, comorbidities, familial history, IgA anti-transglutaminase antibodies (TGA-IgA) at diagnosis, dietary adherence), in children diagnosed with CD between 2014 and 2022 at the Gastroenterology Unit of Maggiore Hospital, Bologna. The minimum follow-up period was 6 months. Of 421 symptomatic patients at diagnosis, 77.4% presented gastrointestinal symptoms (GIs) (40.6% recurrent abdominal pain, 19.5% diarrhea, 21.6% constipation, 17.3% bloating), 47.5% extra-intestinal symptoms (EISs) (16.4% neurological symptoms, 9.0% anemia), and 33.5% growth retardation (31.6% failure to thrive, 17.8% short stature). 96.7% had a high GFD adherence through follow-up. The overall symptom resolution rate was 84.8% (GIs 89.0%, EISs 92.6%, growth retardation 87.4%). Constipation had a significantly lower resolution rate compared to other GIs (p = 0.02) or diarrhea (p = 0.03). In total, 81.7% of patients achieved symptom resolution within 12 months. Short stature and anemia resolved more slowly compared to other symptoms. TGA-IgA normalization and GFD adherence were significant predictors of symptom resolution.

Conclusion: Most symptoms resolved within the first year of diagnosis. The lower resolution rate for constipation compared to other GIs suggests a functional etiology, while the delayed recovery of anemia and short stature likely reflects their complex etiology. Serological normalization and GFD adherence are confirmed as predictors of clinical remission.

What is Known:

• Time to clinical remission in celiac children after starting a gluten-free diet may vary between different symptoms.

• Clinical remission is associated with serological normalization and adherence to diet.

What is New:

• Constipation has a significantly poorer rate of resolution among other gastrointestinal symptoms, due to its functional etiology, while anemia and short stature resolve slightly slower.

• Most patients reach clinical remission within the first year on a gluten-free diet; serological normalization and diet adherence are confirmed to be predictors of clinical remission.