Abstract
Background/Objectives: Celiac disease (CD) is a chronic autoimmune enteropathy with increasing recognition of systemic involvement, including potential microvascular alterations. While nailfold videocapillaroscopy (NVC) is an established tool in rheumatology for assessing microcirculation, its application in pediatric CD remains unexplored. Our aim was to investigate capillaroscopic abnormalities in children with CD and assess their associations with clinical and laboratory parameters, including dietary adherence. Methods: This cross-sectional study included 76 pediatric CD patients and 76 age- and sex-matched healthy controls. All participants underwent standardized NVC evaluation, assessing capillary density, dilatation, morphology, and microhemorrhages. Clinical data, laboratory values, and dietary adherence (based on clinical symptoms and tissue transglutaminase-IgA levels) were recorded. Results: Compared to controls, CD patients exhibited significantly lower capillary density and increased frequencies of dilated capillaries, microhemorrhages, and abnormal morphologies (p < 0.001). A nonspecific NVC pattern predominated among CD patients. Capillary abnormalities were more pronounced in patients without tTG-IgA normalization (>10 U/mL) and with symptoms suggestive of gluten exposure. Additionally, the number of dilated capillaries positively correlated with age and disease duration. No significant differences were found based on ANA status. Conclusions: This is the first study to demonstrate NVC-detectable microvascular alterations in pediatric CD. Findings suggest subclinical microvascular involvement, which may be potentially modifiable through dietary adherence. NVC may serve as a non-invasive tool to detect early vascular changes and monitor systemic manifestations in pediatric CD. Longitudinal studies are warranted to clarify the reversibility and prognostic implications of these abnormalities.