Potential Celiac Disease as a Window Into Gluten-Mediated Enteropathy

Potential celiac disease is defined as having positive celiac serology in the absence of intestinal villous atrophy. This phenotype is common, accounting for ∼1 in 5 celiac patients. Many patients never develop the enteropathy characteristic of active celiac disease, and antibodies may even normalize despite continuing to consume gluten. There is no reliable way to predict who will go on to develop active celiac disease, and there is a lack of evidence on how best to manage these patients. By understanding biochemical and immunologic differences between potential and active celiac disease, we may learn how celiac disease develops and elucidate new targetable pathways to prevent or ameliorate villous atrophy.