Coeliac disease: a histological follow-up study.
OBJECTIVE
To assess the histological response to a gluten-free diet (GFD) in a series of coeliac patients in clinical remission, of different ages and with varying degrees of mucosal damage at diagnosis.


RESULTS
Biopsy samples from 249 coeliac patients (F 165, M 84) were analysed basally and after clinical and biochemical remission following a GFD. All patients showed an improvement in mucosal findings after starting a GFD, but complete histological normalization was observed in 74.1% of paediatric cases (diagnosed before 14 years of age) and in only 17.5% of adults. Statistical analysis showed that sex, the clinical picture at diagnosis and the length of time between biopsy at the time of diagnosis and on a GFD were not related to histological normalization. In contrast, the age at diagnosis was statistically significantly related to it (P < 0.0001). In addition, the presence/absence of Helicobacter pylori was independent of the normalization of the duodenal mucosa.


CONCLUSIONS
In clinical practice the criteria for diagnosis of coeliac disease are sufficiently standardized, whereas for follow-up they are less well defined. We suggest that in order to compare the results from different studies, it should be stated whether remission after treatment is based on clinical or histological criteria or both.
Bardella
M T
MT
Department of Gastroenterology and Endocrine Diseases, Fondazione IRCCS, Ospedale Maggiore Policlinico, Mangialli and Regina Elena, Milano, Italy. mariateresa.bardella@unimi.it
Velio
P
P
Cesana
B M
BM
Prampolini
L
L
Casella
G
G
Di Bella
C
C
Lanzini
A
A
Gambarotti
M
M
Bassotti
G
G
Villanacci
V
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000178:diet therapy / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D018753:Diet, Protein-Restricted; D004386:Duodenum / Q000382:microbiology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000382:microbiology / Q000473:pathology; D005983:Glutens / Q000008:administration & dosage; D016480:Helicobacter pylori; D006801:Humans; D007223:Infant; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013270:Stomach / Q000382:microbiology / Q000473:pathology
D005983:Glutens