The Frequency of Celiac Disease in Siblings of Celiac Patients and Applicability of Non-Biopsy Diagnostic Criteria

Objective: First-degree relatives, especially siblings are at increased risk of developing celiac disease (CD). The aim of this study was to determine the prevalence of CD in siblings of children with CD, and to evaluate the applicability of the non-biopsy diagnostic criteria recommended in the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) 2020 guidelines. Material and Methods: This study was conducted between January 2024 and November 2025. Siblings of children with biopsy-confirmed CD who had not previously been diagnosed with CD were included in the study. According to the ESPGHAN 2020 guidelines, cases with elevated anti-tTG IgA levels (more than 10 times the upper limit of normal) were diagnosed without a biopsy. Results: 250 siblings of 81 children biopsy-confirmed CD were included in the study. The median age of the siblings was 9.00 years. Anti-tTG IgA positivity was detected in 31 siblings. A total of 26 siblings (10.4%) were diagnosed with CD. Of the diagnosed cases, and 21 (80.76%) were asymptomatic. In 12 cases with anti-tTG IgA levels more than 10xULN, the diagnosis was done without biopsy. Conclusion: The prevalence of CD in siblings of celiac patients was found to be 10.4%. This rate is approximately 22 times higher than in the general population in our country. Since half of the diagnosed patients are asymptomatic, screening all siblings for CD, regardless of the presence of symptoms, is crucial for early diagnosis. Additionally, diagnosis can be done without biopsy in eligible cases meeting the ESPGHAN 2020 no-biopsy criteria.