Neurotensin: any clue in pediatric celiac disease?

Background and aims: Neurotensin (NT) is a gut hormone secreted by specific endocrine cells scattered throughout the epithelial layer of the small intestine which has been identified as an important mediator in several gastrointestinal functions and disease conditions. Its potential involvement in celiac disease (CD) has been investigated, but there are conflicting findings. The aim of this study was to evaluate serum NT levels in children with CD at diagnosis comparing to a control group and to investigate if NT correlated in CD patients with symptoms, antibody response and intestinal mucosal damage. Patients and methods: Children who underwent gastrointestinal endoscopy for CD or other clinical reasons were enrolled. Patients with CD diagnosed according to the latest ESPGHAN guidelines without biopsy were also recruited. Fasting serum samples were analyzed for NT levels using ELISA. Mann Whitney, Wilcoxon rank sum and Spearman’s rank tests were used for statistical analysis. Results: 30 children (12M:18F, 1-16 years) were enrolled in this study. Of 25 patients who underwent endoscopy, 9 were CD patients, 13 were controls, 3 were excluded due to unspecific inflammation at duodenal biopsy. CD was diagnosed in 5 patients without biopsy. NT median was higher in CD patients compared to controls (13.25 pg/ml vs 7.8 pg/ml; p = 0.02) (Mann-Whitney and Wilcoxon tests). No statistically significant correlation of NT with clinical, serological or histological data of CD was observed in this cohort. Conclusion: At our knowledge, this is the first Italian study that evaluates NT in pediatric CD. Results show that NT is higher in the serum of CD children at diagnosis compared to controls; however, larger scale studies are required to validate these findings. Whether serum NT levels can be an adjunctive marker for pediatric CD remains currently elusive.