Persistent small bowel mucosal villous atrophy without symptoms in coeliac disease
Article first published online: 12 MAR 2007
Alimentary Pharmacology & Therapeutics
Volume 25, Issue 10, pages 1237–1245, May 2007
How to Cite
KAUKINEN, K., PERÄAHO, M., LINDFORS, K., PARTANEN, J., WOOLLEY, N., PIKKARAINEN, P., KARVONEN, A.-L., LAASANEN, T., SIEVÄNEN, H., MÄKI, M. and COLLIN, P. (2007), Persistent small bowel mucosal villous atrophy without symptoms in coeliac disease. Alimentary Pharmacology & Therapeutics, 25: 1237–1245. doi: 10.1111/j.1365-2036.2007.03311.x
- Issue published online: 12 MAR 2007
- Article first published online: 12 MAR 2007
- Publication data Submitted 24 January 2007First decision 6 February 2007Resubmitted 22 February 2007Accepted 5 March 2007
Background Refractory sprue with malabsorption carries a risk of lymphoma.
Aim To examine whether a good clinical but poor histological response during a strict gluten-free diet predicts a poor outcome.
Methods The study involved all coeliac patients who showed no histological recovery within 2 years on a strict gluten-free diet. Small intestinal biopsy and bone mineral density were investigated in 2001 and clinical features were followed up until 2005. The results were compared to those in 18 coeliac patients with a good histological recovery.
Results Thirteen coeliac patients had persistent small intestinal villous atrophy despite maintaining gluten-free diet. All had demonstrated a good clinical response. Osteoporosis was found in 58% and 22% of the non-responders and responders, respectively (P = 0.04). In 2005, two of the non-responders had developed symptomatic refractory sprue, one died of lymphoma and one of carcinoid tumour, and one gastric adenocarcinoma was operated. None of the 18 controls had developed refractory sprue or malignancy. The frequency of histological non-responsive disease was 1.9%.
Conclusions Persistent villous atrophy in adult coeliac disease, even in the absence of symptoms, carries a risk of subsequent severe complications. The follow-up biopsy is important in detecting these individuals.