Biomarkers for intestinal damage in pediatric celiac disease

Celiac disease (CD) is an immune-mediated enteropathy triggered by gluten in genetically predisposed individuals, affecting around 1% of the global population. Diagnosis relies on serological testing (IgA antibodies to transglutaminase 2 and endomysium), supported by HLA-DQ2/DQ8 typing and duodenal biopsy when indicated. This approach has limitations, including false negatives in IgA deficiency, poor sensitivity in potential or minimal-lesion CD, poor correlation with mucosal healing, and limited ability to predict disease progression. This mini review summarizes non-invasive and minimally invasive biomarkers for the diagnosis and follow-up of CD, with special attention to the pediatric setting. We discuss markers of enterocyte injury (intestinal fatty acid-binding protein, i-FABP; citrulline), immune activation (cytokines, high-mobility group box 1), gluten exposure and barrier function (fecal and urinary gluten immunogenic peptides, zonulin, calprotectin), and molecular signatures emerging from microbiome and multi-omics research. Of these, i-FABP (for diagnosis and follow-up) and gluten immunogenic peptides (for monitoring adherence to a gluten-free diet) appear the most promising. However, assay standardization, age-specific reference ranges, and large-scale prospective pediatric validation remain necessary before routine implementation, and data from regions such as Central Asia are scarce.