title: Celiac disease with mild enteropathy is not mild disease.
abstract: OBJECTIVE
  Patients with celiac disease have varying degrees of damage to the small intestinal mucosa, ranging from lymphocytic duodenosis with normal villous structure to severe villous atrophy. We assessed whether the severity of mucosal lesions was associated with clinical and laboratory features of celiac disease.
  
  
  METHODS
  We compared demographic, clinical, and laboratory characteristics among patients with celiac disease who were classified based on the severity of duodenal lesions. We analyzed data from 1408 adult patients seen consecutively at a tertiary referral center since 1990. Patients were classified as having villous atrophy (n = 1249) or as having mild enteropathy (n = 159) in the presence or absence of villous atrophy.
  
  
  RESULTS
  Similar percentages of patients with villous atrophy, vs mild enteropathy, experienced weight loss (17% vs 17%), gastrointestinal manifestations (70% vs 70%), extraintestinal manifestations (66% vs 57%), and other associated conditions (19% vs 23%). More patients with villous atrophy than patients with mild enteropathy developed osteopenia or osteoporosis (22% vs 5%; P = .0005). Greater percentages of patients with villous atrophy than those with mild enteropathy also had anemia (42% vs 29%; P = .002), folate deficiency (75% vs 64%; P = .02), hypocholesterolemia (7% vs 2%; P = .02), hypocalcemia (26% vs 13%; P = .004), or hyperparathyroidism (45% vs 29%; P = .004).
  
  
  CONCLUSIONS
  Although osteopenia, osteoporosis, and alterations in laboratory parameters are prevalent among patients with celiac disease with mild enteropathy, they are more prevalent and severe in those with villous atrophy. The prevalence of associated conditions is similar between these groups. These results indicate that celiac disease with mild enteropathy is not mild disease, but requires treatment with a gluten-free diet.
authors.affiliation: Gastroenterology Unit, University of Brescia, Brescia, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Zanini
authors.forename: Francesca
authors.initials: F
authors.lastname: Caselani
authors.forename: Alberto
authors.initials: A
authors.lastname: Magni
authors.forename: Daniele
authors.initials: D
authors.lastname: Turini
authors.forename: Alice
authors.initials: A
authors.lastname: Ferraresi
authors.forename: Francesco
authors.initials: F
authors.lastname: Lanzarotto
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Villanacci
authors.forename: Nice
authors.initials: N
authors.lastname: Carabellese
authors.forename: Chiara
authors.initials: C
authors.lastname: Ricci
authors.forename: Alberto
authors.initials: A
authors.lastname: Lanzini
mesh_terms: D000328:Adult; D000368:Aged; D001851:Bone Diseases, Metabolic / Q000453:epidemiology; D002446:Celiac Disease / Q000150:complications* / Q000473:pathology*; D015331:Cohort Studies; D004386:Duodenum / Q000473:pathology*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D055815:Young Adult