title: Is a gluten-free diet necessary in Marsh I intestinal lesions in patients with HLADQ2, DQ8 genotype and without gastrointestinal symptoms?
abstract: OBJECTIVE
  To describe whether a gluten-free diet (GFD) is indicated in Marsh I gluten-sensitive enteropathy where gastrointestinal symptoms are not present. Arguments are provided to prescribe a GFD to manage extraintestinal symptoms. By contrast, there are not enough reasons to prescribe a GFD to prevent long-term complications.
  
  
  RESULTS
  Population-based and prospective observational studies have found that lymphocytic duodenosis may be due to not just gluten-sensitive enteropathy but also due to other aetiologic factors. Marsh I type lesions may be the cause of iron-deficiency anaemia of unknown aetiology which is reverted by a GFD. A similar effect seems to occur with bone mineralization and hypertransaminasemia. The beneficial influence of a GFD reducing lymphoma and coeliac disease-related mortality remains controversial.
  
  
  CONCLUSIONS
  An appropriate differential diagnosis of the lymphocytic duodenosis is essential before a GFD is indicated. As a third of patients remained undiagnosed, in spite of genetic study and specific coeliac serology, flow cytometry and transglutaminase antibodies in duodenal tissue may be helpful in establishing gluten-sensitive enteropathy diagnosis. Future studies should assess whether lymphoma risk is reduced by a GFD in Marsh I patients. Also a more precise benefit in bone mineralization in this setting is needed.
authors.affiliation: Department of Gastroenterology. Hospital Universitari Mútua de Terrassa, Fundació per Recerca Mútua de Terrassa, Universitat de Barcelona, Terrassa, Catalonia, Spain. mestevecomas@telefonica.net
authors.forename: Maria
authors.initials: M
authors.lastname: Esteve
authors.forename: Anna
authors.initials: A
authors.lastname: Carrasco
authors.forename: Fernando
authors.initials: F
authors.lastname: Fernandēz-Bañares
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000209:etiology; D000906:Antibodies / Q000378:metabolism; D015519:Bone Density; D002446:Celiac Disease / Q000178:diet therapy* / Q000235:genetics / Q000473:pathology; D003937:Diagnosis, Differential; D055050:Diet, Gluten-Free; D004378:Duodenal Diseases / Q000178:diet therapy* / Q000235:genetics / Q000473:pathology; D004386:Duodenum / Q000276:immunology / Q000473:pathology*; D005838:Genotype; D006683:HLA-DQ Antigens / Q000235:genetics; D006801:Humans; D008214:Lymphocytes / Q000473:pathology*; D008223:Lymphoma / Q000517:prevention & control; D011503:Transglutaminases / Q000276:immunology*
chemical_list: D000906:Antibodies; D006683:HLA-DQ Antigens; D011503:Transglutaminases