Histologic follow-up of people with celiac disease on a gluten-free diet: slow and incomplete recovery.
To assess histologic recovery in response to gluten withdrawal in celiac disease, 158 patients seen in our hospital during a 15-year period underwent follow-up small intestine biopsies (SIBs) within 2 years after starting a gluten-free diet; further SIBs were done if villous atrophy was present. A modified Marsh classification was used (IIIA, partial villous atrophy; IIIB, subtotal villous atrophy; IIIC, total villous atrophy). Of patients with Marsh IIIA, IIIB, or IIIC lesions, histologic remission was seen in 65.0% within 2 years, 85.3% within 5 years, and 89.9% in long-term follow-up. Eleven patients (7.0%) with persisting (partial) villous atrophy had symptoms and signs of malabsorption and were considered to have refractory celiac disease; 5 of them developed an enteropathy-associated T-cell lymphoma. Children recovered up to 95% within 2 years and 100% in the long-term. Histologic recovery in celiac disease after starting a gluten-free diet takes time and is incomplete or absent in a substantial subgroup of patients (10.1% villous atrophy after 5 years). Systematic follow-up of patients with celiac disease and the malabsorption syndrome and secondary complications is needed.
Wahab
Peter J
PJ
Department of Gastroenterology and Hepatology, Rijnstate Hospital Arnhem, The Netherlands.
Meijer
Jos W R
JW
Mulder
Chris J J
CJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001284:Atrophy / Q000473:pathology; D001706:Biopsy; D002446:Celiac Disease / Q000150:complications / Q000178:diet therapy / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004032:Diet; D005260:Female; D005500:Follow-Up Studies; D005983:Glutens / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007413:Intestinal Mucosa / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology*; D016399:Lymphoma, T-Cell / Q000150:complications / Q000473:pathology; D008286:Malabsorption Syndromes / Q000150:complications / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D016896:Treatment Outcome
D005983:Glutens