title: Complete recovery of intestinal mucosa occurs very rarely in adult coeliac patients despite adherence to gluten-free diet.
abstract: BACKGROUND
  Expected benefits of gluten-free diet (GFD) in coeliac patients include healing of small intestinal mucosa, but it remains unclear to what extent this benefit is achieved in adults.
  
  
  OBJECTIVE
  To assess factors affecting histological outcome of GFD in a large cohort of adult coeliac patients.
  
  
  METHODS
  We extracted information on 465 consecutive coeliac patients studied before and during GFD.
  
  
  RESULTS
  Duodenal biopsies at diagnosis were classified as Marsh I in 11, II in 25 and III in 429 cases. After a median 16 months GFD, 38 (8%) patients had histological 'normalization', 300 (65%) had 'remission' with persistent intraepithelial lymphocytosis, 121(26%) had 'no change' and 6 (1%) had 'deterioration'. Coeliac disease related serology was negative in 83% of patients with Marsh III lesion during GFD. Male gender and adherence to GFD were independently associated with histological 'normalization' and 'remission'. Persistence of intraepithelial lymphocytosis was not associated with human lymphocyte antigen gene dose or with Helicobacter pylori infection.
  
  
  CONCLUSIONS
  Complete normalization of duodenal lesions is exceptionally rare in adult coeliac patients despite adherence to GFD, symptoms disappearance and negative CD related serology. Control biopsies are mandatory to identify lack of response to gluten-free diet.
authors.affiliation: Gastroenterology Unit, University and Spedali Civili of Brescia, Brescia, Italy. lanzini@med.unibs.it
authors.forename: A
authors.initials: A
authors.lastname: Lanzini
authors.forename: F
authors.initials: F
authors.lastname: Lanzarotto
authors.forename: V
authors.initials: V
authors.lastname: Villanacci
authors.forename: A
authors.initials: A
authors.lastname: Mora
authors.forename: S
authors.initials: S
authors.lastname: Bertolazzi
authors.forename: D
authors.initials: D
authors.lastname: Turini
authors.forename: G
authors.initials: G
authors.lastname: Carella
authors.forename: A
authors.initials: A
authors.lastname: Malagoli
authors.forename: G
authors.initials: G
authors.lastname: Ferrante
authors.forename: B M
authors.initials: BM
authors.lastname: Cesana
authors.forename: C
authors.initials: C
authors.lastname: Ricci
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002446:Celiac Disease / Q000178:diet therapy* / Q000473:pathology; D015331:Cohort Studies; D055050:Diet, Gluten-Free / Q000379:methods*; D004386:Duodenum / Q000473:pathology*; D005260:Female; D005983:Glutens / Q000008:administration & dosage*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D013223:Statistics as Topic; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005983:Glutens