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Scand J Gastroenterol. 2016 Dec;51(12):1439-1446. Epub 2016 Aug 18.

Long-term mucosal recovery and healing in celiac disease is the rule - not the exception.

Author information

1
a Department of Gastroenterology , Sørlandet Hospital HF , Arendal , Norway.
2
b Department of Pathology , Sørlandet Hospital HF , Kristiansand , Norway.
3
c Department of Pathology , Oslo University Hospital , Oslo , Norway.
4
d CIR - Centre for Immune Regulation in Oslo, Oslo University Hospital, University of Oslo , Oslo , Norway.

Abstract

OBJECTIVE:

The prevalence of persistent villous atrophy (VA) in patients with celiac disease (CD) on a gluten-free diet (GFD) varies greatly between studies. Most studies show a relatively high prevalence of mucosal atrophy and inflammation in treated patients, a finding which have led to a concept of non-responsive CD. Few studies have examined the prevalence of long-term mucosal healing. Our study aimed to determine the extent of mucosal healing in a cohort of Norwegian patients with CD treated with GFD for several years.

MATERIALS AND METHODS:

Adult patients diagnosed with VA between 1989 and 2009 were included. We performed a follow-up gastroscopy with duodenal biopsies. Two pathologists evaluated the biopsies according to the Marsh-Oberhuber classification. Mucosal healing was defined as Marsh 0 while mucosal recovery was defined as Marsh 0-2.

RESULTS:

Duodenal biopsies were obtained from 127 adult patients with established CD. After a follow-up time of 8.1 years (median, range 2.3-22.3), 103 (81%) of the patients showed mucosal healing, 120 patients (94%) showed mucosal recovery, and 7 patients (6%) showed persistent VA. In addition, 103 of the 127 patients (81%) had undergone a routine follow-up biopsy 12.6 months (median, range 5.2-28.8) after diagnosis. At the time of the routine follow-up, only 52 of these patients (50.5%) had achieved mucosal recovery.

CONCLUSIONS:

Although half of the patients had persistent VA at the time of routine follow-up, both long-term mucosal recovery and healing is possible for the vast majority of adult patients with CD.

KEYWORDS:

Celiac disease; endoscopy general; gastroduodenal clinic; malabsorption mucosal function; nutrition; small intestinal disorders

PMID:
27534885
DOI:
10.1080/00365521.2016.1218540
[Indexed for MEDLINE]

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