Clinical symptoms in celiac patients on a gluten-free diet.
OBJECTIVE
Persistent villous atrophy in patients with celiac disease (CD) on a gluten-free diet (GFD) is reported with increasing frequency. The aim of this study was to evaluate a possible association between persistent damage of the villi and "atypical" gastrointestinal symptoms in CD patients on a GFD.


METHODS
Sixty-nine CD patients on a GFD were divided into two groups: Group A included 42 patients (6 M, 36 F, age range 17-62 years) undergoing esophagogastroduodenoscopies (EGDs) due to the presence of symptoms; Group B included 27 control patients (6 M, 21 F, age range 24-71 years) who were asymptomatic at the time of the study. Both groups underwent EGDs and a duodenal histologic study.


RESULTS
Persistent endoscopic lesions were more frequent in Group A (30/42) than in Group B (12/27; p=0.01). Villous atrophy was significantly more frequent in Group A than in Group B: 85% versus 33% (p<0.0001; odds ratio (OR)=12; 95% CI 3.7-38.9). Gastrointestinal symptoms in the Group A patients were different from those present at CD diagnosis: anemia/diarrhea/weight loss in 6 cases; gastroesophageal reflux disease (GERD)-like symptoms in 12 cases; abdominal pain/constipation in 24 cases. In Group A there was no difference in gender distribution, age and duration of GFD between subjects with normal villi and those with persistent partial villous atrophy. Patients with persistent symptoms showed a higher intraepithelial eosinophil count (p=0.005) than the asymptomatic patients (p=0.01).


CONCLUSIONS
Persistent intestinal villous atrophy in CD patients on a GFD is associated with gastrointestinal symptoms considered "atypical" for CD and not present at CD diagnosis.
Carroccio
Antonio
A
Department of Internal Medicine, University of Palermo, Hospital of Sciacca (AG), Italy. acarroccio@hotmail.com
Ambrosiano
Giuseppe
G
Di Prima
Lidia
L
Pirrone
Giuseppe
G
Iacono
Giuseppe
G
Florena
Ada M
AM
Porcasi
Rossana
R
Noto
Davide
D
Fayer
Francesca
F
Soresi
Maurizio
M
Geraci
Girolamo
G
Sciumè
Carmelo
C
Di Fede
Gaetana
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000178:diet therapy* / Q000473:pathology*; D055050:Diet, Gluten-Free; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome