Year 2024 / Volume 116 / Number 7
Original
Assessing mucosal recovery in celiac disease - Time to diagnosis and histological severity as determining factors

356-361

DOI: 10.17235/reed.2024.9968/2023

Laura Rodríguez-Martín, Luis Manuel Vaquero Ayala, Mercedes Hernando Martín, Santiago Vivas Alegre,

Abstract
Background and objectives: there is a huge disparity in mucosal recovery among celiac patients on a gluten-free diet. We report a study to identify associated factors. Methods: celiac cases were collected that had positive celiac serology and villous atrophy at diagnosis, and had undergone a control biopsy after at least 12 months of follow-up. Results: seventy celiac patients were included and had experienced symptoms for 9.05 ± 9.48 years before being diagnosed. After follow-up for 2.93 ± 1.94 years, 34.3 % had complete mucosal recovery and 57.1 % had partial mucosal recovery. In the comparative analysis, there was no relationship between mucosal recovery and sex, age, clinical manifestations or follow-up time from diagnosis to the second biopsy. Time with clinical manifestations before diagnosis was associated with a worse outcome: 2.64 years in patients with full recovery, 4.61 years in patients with partial recovery, and 14.26 years in patients with persistent villous atrophy. Higher transglutaminase antibody titers both at diagnosis and during follow-up were associated with poorer histologic outcomes. We observed higher mucosal recovery rates in patients with mild atrophy versus severe atrophy at diagnosis. Conclusions: in spite of a gluten-free diet, a significant proportion of patients have persistent histologic changes. Time with clinical manifestations before diagnosis is key for histological severity and recovery.
Lay Summary
Introduction: Celiac disease produces intestinal damage due to ingestion of gluten. Gluten-free diet (GFD) is presently the sole effective treatment for celiac disease. However, there is great disparity in mucosal recovery among celiac patients on a gluten-free diet. We report a study to identify associated factors with mucosal recovery. Methods: Celiac case were collected that had positive celiac serology and villous atrophy at diagnosis, and had undergone a control biopsy after at least 12 months of follow-up. Results: We included 70 celiac patients and had experienced symptoms for 9.05 years before being diagnosed. After follow-up for 2.93 years, 34.3 % had complete mucosal recovery and 57.1 % had partial mucosal recovery. In the comparative analysis we found no relationship between mucosal recovery and sex, age, clinical manifestations or follow-up time from diagnosis to second biopsy. Time with clinical manifestations before diagnosis and higher transglutaminase antibody titers both at diagnosis and during follow-up were associated with poorer histologic outcomes. Conclusions: In spite of gluten-free diet, a significant proportion of patients have persistent histologic changes. Time with clinical manifestations before diagnosis is key for histological severity and recovery.
Share Button
New comment
Comments

24/07/2024 16:52:24
Acunetix


24/07/2024 16:51:29


24/07/2024 16:49:22
Acunetix


24/07/2024 16:48:08


24/07/2024 16:45:35
Acunetix


24/07/2024 16:44:34


24/07/2024 16:06:30


24/07/2024 16:06:29


24/07/2024 16:06:28


24/07/2024 16:06:28



Page 1 of 90  
1
2
3
4
5
6
7
8
9
10
11
>>
References
1. Lebwohl B, Granath F, Ekbom A, et al. Mucosal healing and risk for lymphoproliferative malignancy in celiac disease: a population-based cohort study. Ann Intern Med 2013;159:169-75.
2. Lebwohl B, Michaelsson K, Green PH, et al. Persistent mucosal damage and risk of fracture in celiac disease. J Clin Endocrinol Metab 2014;99:609-16.
3. Ludvigsson JF, Montgomery SM, Ekbom A, et al. Small-intestinal histopathology and mortality risk in celiac disease. JAMA 2009;302:1171-8.
4. Husby S, Bai JC. Follow-up of Celiac Disease. Gastroenterol Clin North Am 2019;48:127-36.
5. Murray JA, Watson T, Clearman B, et al. Effect of a gluten-free diet on gastrointestinal symptoms in celiac disease. Am J Clin Nutr 2004;79:669-73.
6. Bannister EG, Cameron DJ, Ng J, et al. Can celiac serology alone be used as a marker of duodenal mucosal recovery in children with celiac disease on a gluten-free diet? Am J Gastroenterol 2014;109:1478-83.
7. Leonard MM, Weir DC, DeGroote M, et al. Value of IgA tTG in Predicting Mucosal Recovery in Children With Celiac Disease on a Gluten-Free Diet. J Pediatr Gastroenterol Nutr 2017;64:286-91.
8. Mandile R, Maglio M, Mosca C, et al. Mucosal Healing in Celiac Disease: Villous Architecture and Immunohistochemical Features in Children on a Long-Term Gluten Free Diet. Nutrients 2022;14.
9. Sharkey LM, Corbett G, Currie E, et al. Optimising delivery of care in coeliac disease - comparison of the benefits of repeat biopsy and serological follow-up. Alimentary pharmacology & therapeutics 2013;38:1278-91.
10. Rubio-Tapia A, Rahim MW, See JA, et al. Mucosal recovery and mortality in adults with celiac disease after treatment with a gluten-free diet. Am J Gastroenterol 2010;105:1412-20.
11. Haere P, Hoie O, Schulz T, et al. Long-term mucosal recovery and healing in celiac disease is the rule - not the exception. Scand J Gastroenterol 2016;51:1439-46.
12. Lebwohl B, Murray JA, Rubio-Tapia A, et al. Predictors of persistent villous atrophy in coeliac disease: a population-based study. Alimentary pharmacology & therapeutics 2014;39:488-95.
13. Lanzini A, Lanzarotto F, Villanacci V, et al. Complete recovery of intestinal mucosa occurs very rarely in adult coeliac patients despite adherence to gluten-free diet. Alimentary pharmacology & therapeutics 2009;29:1299-308.
14. Galli G, Esposito G, Lahner E, et al. Histological recovery and gluten-free diet adherence: a prospective 1-year follow-up study of adult patients with coeliac disease. Alimentary pharmacology & therapeutics 2014;40:639-47.
15. Collin P, Maki M, Kaukinen K. Complete small intestine mucosal recovery is obtainable in the treatment of celiac disease. Gastrointest Endosc 2004;59:158-9; author reply 9-60.
16. Bardella MT, Velio P, Cesana BM, et al. Coeliac disease: a histological follow-up study. Histopathology 2007;50:465-71.
17. Ciacci C, Cirillo M, Cavallaro R, et al. Long-term follow-up of celiac adults on gluten-free diet: prevalence and correlates of intestinal damage. Digestion 2002;66:178-85.
18. Kaukinen K, Sulkanen S, Maki, et al. IgA-class transglutaminase antibodies in evaluating the efficacy of gluten-free diet in coeliac disease. Eur J Gastroenterol Hepatol 2002;14:311-5.
19. Grefte JM, Bouman JG, Grond J, et al. Slow and incomplete histological and functional recovery in adult gluten sensitive enteropathy. Journal of clinical pathology 1988;41:886-91.
20. Hutchinson JM, West NP, Robins GG, et al. Long-term histological follow-up of people with coeliac disease in a UK teaching hospital. Qjm 2010;103:511-7.
21. Lee SK, Lo W, Memeo L, et al. Duodenal histology in patients with celiac disease after treatment with a gluten-free diet. Gastrointest Endosc 2003;57:187-91.
22. Newnham ED, Shepherd SJ, Strauss BJ, et al. Adherence to the gluten-free diet can achieve the therapeutic goals in almost all patients with coeliac disease: A 5-year longitudinal study from diagnosis. J Gastroenterol Hepatol 2016;31:342-9.
23. Tuire I, Marja-Leena L, Teea S, et al. Persistent duodenal intraepithelial lymphocytosis despite a long-term strict gluten-free diet in celiac disease. Am J Gastroenterol 2012;107:1563-9.
24. Tursi A, Brandimarte G, Giorgetti GM, et al. Endoscopic and histological findings in the duodenum of adults with celiac disease before and after changing to a gluten-free diet: a 2-year prospective study. Endoscopy 2006;38:702-7.
25. Wahab PJ, Meijer JW, Mulder CJ. Histologic follow-up of people with celiac disease on a gluten-free diet: slow and incomplete recovery. Am J Clin Pathol 2002;118:459-63.
26. Szakacs Z, Matrai P, Hegyi P, et al. Younger age at diagnosis predisposes to mucosal recovery in celiac disease on a gluten-free diet: A meta-analysis. PLoS One 2017;12:e0187526.
27. Sadeghi A, Rad N, Ashtari S, et al. The value of a biopsy in celiac disease follow up: assessment of the small bowel after 6 and 24 months treatment with a gluten free diet. Rev Esp Enferm Dig 2020;112:101-8.
28. Izquierdo Santervas S, Fernandez Salazar L. Villous atrophy persistence in celiac disease despite following a gluten-free diet must be clarified. Rev Esp Enferm Dig 2021;113:76.
29. Pekki H, Kurppa K, Maki M, et al. Predictors and Significance of Incomplete Mucosal Recovery in Celiac Disease After 1 Year on a Gluten-Free Diet. Am J Gastroenterol 2015;110:1078-85.
30. Vaquero L, Rodriguez-Martin L, Alvarez-Cuenllas B, et al. Coeliac disease and gastrointestinal symptom screening in adult first-degree relatives. J Gastroenterol Hepatol 2017;32:1931-7.
31. Zanini B, Caselani F, Magni A, et al. Celiac disease with mild enteropathy is not mild disease. Clin Gastroenterol Hepatol 2013;11:253-8.
32. Seetharaman K, Lal SB, Prasad KK, et al. Role of Serology, Dietary Assessment, and Fecal Gluten Immunogenic Peptides for Predicting Histologic Recovery in Children with Celiac Disease. Dig Dis Sci 2023;68:529-40.
33. Comino I, Fernandez-Banares F, Esteve M, et al. Fecal Gluten Peptides Reveal Limitations of Serological Tests and Food Questionnaires for Monitoring Gluten-Free Diet in Celiac Disease Patients. Am J Gastroenterol 2016;111:1456-65.
Related articles

Letter

Liver disorders and celiac disease

DOI: 10.17235/reed.2023.9516/2023

Digestive Diseases Image

Villous atrophy, an endoscopic and diagnostic challenge

DOI: 10.17235/reed.2021.8169/2021

Digestive Diseases Image

Calcified cavitating mesenteric lymph node syndrome: a rare complication of celiac disease

DOI: 10.17235/reed.2020.7494/2020

Letter

Balanced by iron. Hereditary hemochromatosis and celiac disease

DOI: 10.17235/reed.2020.7269/2020

Review

New celiac disease biomarkers

DOI: 10.17235/reed.2020.7217/2020

Editorial

Is celiac disease really associated with inflammatory bowel disease?

DOI: 10.17235/reed.2019.6779/2019

Original

Coping with celiac disease: how heavy is the burden for caregivers?

DOI: 10.17235/reed.2017.4518/2016

Letter to the Editor

Celiac disease and fibromyalgia: Is there an association?

DOI: 10.17235/reed.2015.3992/2015

Letter to the Editor

Sprue-like enteropathy due to olmesartan

DOI: 10.17235/reed.2015.3791/2015

Citation tools
Rodríguez-Martín L, Vaquero Ayala L, Hernando Martín M, Vivas Alegre S. Assessing mucosal recovery in celiac disease - Time to diagnosis and histological severity as determining factors . 9968/2023


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1359 visits.
This article has been downloaded 831 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 19/09/2023

Accepted: 06/12/2023

Online First: 11/01/2024

Published: 08/07/2024

Article revision time: 71 days

Article Online First time: 114 days

Article editing time: 293 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology