title: Gastrointestinal symptoms, quality of life and bone mineral density in mild enteropathic coeliac disease: a prospective clinical trial.
abstract: OBJECTIVE
  The diagnosis of coeliac disease requires small-bowel mucosal villous atrophy with crypt hyperplasia. However, patients with endomysial antibodies but structurally normal villi may suffer from a disorder similar to those with villous atrophy. The aim of this study was to evaluate gastrointestinal symptoms, quality of life and bone mineral density in patients with mild enteropathy, and the effect of a gluten-free diet.
  
  
  METHODS
  A prospective trial was carried out in 73 adults having endomysial antibodies with normal villous morphology (Marsh I-II; mild enteropathy) or villous atrophy (Marsh III). Gastrointestinal symptoms and quality of life were surveyed by means of structured questionnaires and bone mineral density by means of X-ray absorptiometry. Altogether, 110 subjects served as non-coeliac controls.
  
  
  RESULTS
  At baseline, patients with mild enteropathy evinced more gastrointestinal symptoms than non-coeliac controls, but there were no significant differences in quality of life between the groups. After 1 year on a gluten-free diet, indigestion and depression were significantly alleviated in the mild enteropathy group. Osteoporosis or osteopenia was detected in 58% of subjects in the mild enteropathy group and there was a trend towards improved bone mineral density after the treatment.
  
  
  CONCLUSIONS
  Endomysial antibody-positive patients with normal villous structure may suffer from gastrointestinal symptoms and have poor bone health. Furthermore, they benefit from a gluten-free diet similar to those with overt villous atrophy.
authors.affiliation: Paediatric Research Centre, University of Tampere and Tampere University Hospital, Tampere, Finland.
authors.forename: Kalle
authors.initials: K
authors.lastname: Kurppa
authors.forename: Pekka
authors.initials: P
authors.lastname: Collin
authors.forename: Harri
authors.initials: H
authors.lastname: Sievänen
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.forename: Markku
authors.initials: M
authors.lastname: Mäki
authors.forename: Katri
authors.initials: K
authors.lastname: Kaukinen
mesh_terms: D000328:Adult; D001323:Autoantibodies; D015519:Bone Density; D002446:Celiac Disease / Q000276:immunology* / Q000473:pathology*; D055050:Diet, Gluten-Free; D005260:Female; D006801:Humans; D008297:Male; D008871:Microvilli / Q000276:immunology / Q000473:pathology*; D011788:Quality of Life; D012720:Severity of Illness Index
chemical_list: D001323:Autoantibodies