title: Predictors of persistent villous atrophy in coeliac disease: a population-based study.
abstract: BACKGROUND
  Villous atrophy (VA) with intraepithelial lymphocytosis is the histological hallmark of coeliac disease (CD), but reported rates of mucosal recovery are variable.
  
  
  OBJECTIVE
  To determine the impact of age and other demographic variables on the probability of persistent VA on follow-up biopsy.
  
  
  METHODS
  We identified patients with VA on duodenal histology at all 28 Swedish pathology departments during the years spanning 1969-2008. We examined age, gender, calendar period, duration of disease and educational attainment to determine predictors of persistent VA.
  
  
  RESULTS
  Of 7648 patients with CD who underwent follow-up biopsy, persistent VA was present in 3317 (43%; 95% CI 42-44%). The effect of age on persistent VA varied according to time period; among those biopsied in the years spanning 2000-2008, the prevalence of persistent VA was 31%, and increasing age was associated with increasing rates of persistent VA (17% among those younger than 2 years compared to 56% among those ≥70 years). In contrast, persistent VA did not vary widely by age in earlier years. On multivariate analysis (restricted to the calendar period 2000-2008, 2-5 years after CD diagnosis), persistent VA was more common among males (OR 1.43; 95% CI 1.07-1.90) and less common among patients with higher educational attainment (OR for college degree vs. <2 years of high school 0.52, 95% CI 0.35-0.78).
  
  
  CONCLUSIONS
  The prevalence of persistent villous atrophy has changed over time, with greater rates of healing in recent years. Social differences in persistent villous atrophy suggest that access and/or education regarding the gluten-free diet impact mucosal healing.
authors.affiliation: Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA; Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Lebwohl
authors.forename: J A
authors.initials: JA
authors.lastname: Murray
authors.forename: A
authors.initials: A
authors.lastname: Rubio-Tapia
authors.forename: P H R
authors.initials: PH
authors.lastname: Green
authors.forename: J F
authors.initials: JF
authors.lastname: Ludvigsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001284:Atrophy / Q000453:epidemiology / Q000473:pathology; D001706:Biopsy; D002446:Celiac Disease / Q000178:diet therapy / Q000453:epidemiology / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000473:pathology*; D005260:Female; D006801:Humans; D007223:Infant; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008871:Microvilli / Q000473:pathology*; D008875:Middle Aged; D015995:Prevalence; D013548:Sweden / Q000453:epidemiology; D014945:Wound Healing; D055815:Young Adult