Complete recovery of intestinal mucosa occurs very rarely in adult coeliac patients despite adherence to gluten-free diet
Article first published online: 3 MAR 2009
© 2009 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 29, Issue 12, pages 1299–1308, June 2009
How to Cite
LANZINI, A., LANZAROTTO, F., VILLANACCI, V., MORA, A., BERTOLAZZI, S., TURINI, D., CARELLA, G., MALAGOLI, A., FERRANTE, G., CESANA, B. M. and RICCI, C. (2009), Complete recovery of intestinal mucosa occurs very rarely in adult coeliac patients despite adherence to gluten-free diet. Alimentary Pharmacology & Therapeutics, 29: 1299–1308. doi: 10.1111/j.1365-2036.2009.03992.x
- Issue published online: 21 MAY 2009
- Article first published online: 3 MAR 2009
- Publication data Submitted 3 February 2009 First decision 14 February 2009 Resubmitted 25 February 2009 Accepted 26 February 2009 Epub Accepted Article 3 March 2009
Background Expected benefits of gluten-free diet (GFD) in coeliac patients include healing of small intestinal mucosa, but it remains unclear to what extent this benefit is achieved in adults.
Aim To assess factors affecting histological outcome of GFD in a large cohort of adult coeliac patients.
Methods We extracted information on 465 consecutive coeliac patients studied before and during GFD.
Results Duodenal biopsies at diagnosis were classified as Marsh I in 11, II in 25 and III in 429 cases. After a median 16 months GFD, 38 (8%) patients had histological ‘normalization’, 300 (65%) had ‘remission’ with persistent intraepithelial lymphocytosis, 121(26%) had ‘no change’ and 6 (1%) had ‘deterioration’. Coeliac disease related serology was negative in 83% of patients with Marsh III lesion during GFD. Male gender and adherence to GFD were independently associated with histological ‘normalization’ and ‘remission’. Persistence of intraepithelial lymphocytosis was not associated with human lymphocyte antigen gene dose or with Helicobacter pylori infection.
Conclusions Complete normalization of duodenal lesions is exceptionally rare in adult coeliac patients despite adherence to GFD, symptoms disappearance and negative CD related serology. Control biopsies are mandatory to identify lack of response to gluten-free diet.