title: Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease.
abstract: OBJECTIVE
  Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease.
  
  
  METHODS
  We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time.
  
  
  RESULTS
  The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy.
  
  
  CONCLUSIONS
  Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.
authors.affiliation: Department of Medicine, Pediatrics and Pathology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
authors.forename: P
authors.initials: P
authors.lastname: Brar
authors.forename: G Y
authors.initials: GY
authors.lastname: Kwon
authors.forename: I I
authors.initials: II
authors.lastname: Egbuna
authors.forename: S
authors.initials: S
authors.lastname: Holleran
authors.forename: R
authors.initials: R
authors.lastname: Ramakrishnan
authors.forename: G
authors.initials: G
authors.lastname: Bhagat
authors.forename: P H R
authors.initials: PH
authors.lastname: Green
mesh_terms: D000328:Adult; D001284:Atrophy / Q000473:pathology; D001706:Biopsy; D002446:Celiac Disease / Q000473:pathology*; D015331:Cohort Studies; D004386:Duodenum / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008871:Microvilli / Q000473:pathology; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index