Degree of damage to the small bowel and serum antibody titers correlate with clinical presentation of patients with celiac disease.
OBJECTIVE
In patients with celiac disease, gluten-induced lesions of the small-bowel mucosa develop gradually. However, it is not clear whether clinical presentation correlates with the degree of mucosal damage based on histology analysis. We investigated whether the degree of mucosal damage to the small bowel correlates with clinical presentation and serum markers of celiac disease.


METHODS
We collected results from serology tests and mucosal biopsy samples from 638 consecutive patients with celiac disease and compared them with reported gastrointestinal symptoms, health-related quality-of-life scores, results from laboratory tests, and bone mineral densities of patients. We assessed mucosal injury based on the ratio of villous height to crypt depth, numbers of intraepithelial CD3(+) cells, and semiquantitative Marsh classification criteria. Correlations were established based on the Pearson or Spearman coefficients.


RESULTS
The ratio of the villous height to crypt depth correlated with the severity of gastrointestinal symptoms, quality-of-life scores, laboratory test results, numbers of intraepithelial CD3(+) cells, and serum levels of antibodies associated with celiac disease. There was no correlation between the ratio of villous height to crypt depth and bone mineral density. The number of intraepithelial CD3(+) cells was not associated with symptoms, whereas the Marsh classification and serum levels of antibodies associated with celiac disease correlated with gastrointestinal symptoms, laboratory test results, and numbers of intraepithelial CD3(+) cells.


CONCLUSIONS
The ratio of small-bowel villous height to crypt depth and results from serology tests correlate with reported symptoms and quality of life of patients with celiac disease. Patient-reported outcomes are therefore of value, in addition to histology findings, in assessing patients with celiac disease.
Pediatric Research Centre, University of Tampere and Tampere University Hospital, Tampere, Finland.
Juha
J
Taavela
Kalle
K
Kurppa
Pekka
P
Collin
Marja-Leena
ML
Lähdeaho
Teea
T
Salmi
Päivi
P
Saavalainen
Katri
K
Haimila
Heini
H
Huhtala
Kaija
K
Laurila
Harri
H
Sievänen
Markku
M
Mäki
Katri
K
Kaukinen
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000097:blood*; D001706:Biopsy; D002446:Celiac Disease / Q000276:immunology* / Q000473:pathology*; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D044967:Serum / Q000737:chemistry; D055815:Young Adult
D000906:Antibodies