Effect of a gluten-free diet on growth and small-bowel histology in children with celiac disease in India.
OBJECTIVE
Follow-up studies on growth and histological recovery of children with celiac disease (CD) while on a gluten-free diet (GFD) are lacking from Asia. We therefore assessed the effects of this diet.


METHODS
Forty-two children with CD were enrolled. Weight and height were expressed as weight for height (WfH) and height standard deviation scores (HSDS), respectively. Twenty-five children had repeated duodenal biopsies after 1-2 years and 14 had a third biopsy after 3-7 years of GFD. Compliance was checked by regular interview and IgA antiendomysial antibody estimation (EMA).


RESULTS
At diagnosis (n = 25), mean HSDS was -3.3 +/- 1.6 with 76% having a HSDS of <-2; 60% were undernourished (WfH mean 81.6 +/- 5.7). Over a mean follow up of 3.7 years, HSDS improved to -1.3 +/- 1.7 and 84% cases achieved normal nutrition. Mean height velocity was 13.9 cm during first year and 5.6 cm in subsequent years. Small-bowel biopsies at diagnosis showed subtotal villous atrophy (Marsh IIIb) in 18 (72%) and partial villous atrophy (Marsh IIIa) in seven (28%) patients. Repeat biopsy at 1-2 years showed shift from subtotal to partial villous atrophy in 94% (n = 17/18) and normalization in one patient. In patients with Marsh IIIa improvement of partial villous atrophy was observed in all. Immunoglobulin A endomysial antibody was negative in 81%. Repeat biopsies at 5 years of GFD showed improvement to Marsh I-II, but none normalized.


CONCLUSIONS
The majority of children with CD show normalization of nutrition and growth after GFD. Small-bowel histology improves markedly but does not normalize even after 5 years of GFD.
Yachha
Surender K
SK
Department of Gastroenterology (Pediatric Gastroenterology), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. skyachha@sgpgi.ac.in
Srivastava
Anshu
A
Mohindra
Samir
S
Krishnani
Narendra
N
Aggarwal
Rakesh
R
Saxena
Anita
A
D000293:Adolescent; D001707:Biopsy, Needle; D001827:Body Height; D001835:Body Weight; D002446:Celiac Disease / Q000150:complications / Q000178:diet therapy* / Q000473:pathology / Q000503:physiopathology; D002648:Child; D015362:Child Nutrition Disorders / Q000209:etiology; D002675:Child, Preschool; D004386:Duodenum / Q000473:pathology*; D005260:Female; D005983:Glutens / Q000008:administration & dosage; D006128:Growth; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male
D005983:Glutens