Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease.
It is often difficult to assess small bowel recovery in adults with coeliac disease on a gluten-free diet (GFD). This prospective study compares changes in intestinal permeability with changes in intestinal biopsy at various intervals after commencing a GFD. Intestinal permeability was measured by lactulose/rhamnose absorption from 1 week to 24 months after commencing a GFD. Intestinal morphometry was measured by villus area, crypt length and mitotic count per crypt at diagnosis and after commencing a GFD. Median intestinal permeability values decreased from 0.47 (n = 35) at diagnosis to 0.25 (n = 17) after 1 week and to 0.16 (n = 18) after 2 months of a GFD. Rhamnose absorption improved significantly at an early stage, from 6.6% (untreated) to 15.4% at 3 months of a GFD, whereas the decrease in lactulose permeation took longer: from 3.4% (untreated) to 0.8% after 12 months of a GFD. Mean villus area (n = 29) was reduced to 16% of control values at diagnosis, and improved to a maximum of 48% after 6 months on a GFD, but did not change thereafter. Mean crypt length and mitotic count per crypt were increased by 222% and 356% respectively at diagnosis, and these parameters remained elevated at 172% and 216% above control values after 6 months of a GFD. We conclude that intestinal permeability improves within 2 months after starting a GFD, but that measurable intestinal biopsy improvement requires ingestion of a GFD for at least 3-6 months, and even then remains incomplete.
Department of Gastroenterology and Hepatology, DX 465384, The Queen Elizabeth Hospital, Woodville South, SA 5011, Australia. adrian.cummins@nwahs.sa.gov.au
A G
AG
Cummins
F M
FM
Thompson
R N
RN
Butler
J C
JC
Cassidy
D
D
Gillis
M
M
Lorenzetti
E K
EK
Southcott
P C
PC
Wilson
D000293:Adolescent; D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood; D001706:Biopsy; D002446:Celiac Disease / Q000178:diet therapy* / Q000473:pathology / Q000503:physiopathology; D004386:Duodenum / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005903:Gliadin / Q000276:immunology; D005983:Glutens / Q000008:administration & dosage; D006801:Humans; D007408:Intestinal Absorption / Q000502:physiology*; D007792:Lactulose / Q000652:urine; D008297:Male; D008875:Middle Aged; D010539:Permeability; D011446:Prospective Studies; D012210:Rhamnose / Q000652:urine; D013997:Time Factors; D016896:Treatment Outcome
D001323:Autoantibodies; D007792:Lactulose; D005983:Glutens; D005903:Gliadin; D012210:Rhamnose