title: Histological recovery and gluten-free diet adherence: a prospective 1-year follow-up study of adult patients with coeliac disease.
abstract: BACKGROUND
  Adequate gluten-free diet (GFD) is the only treatment for coeliac disease (CD). However, no agreement has been reached on either how and when to assess patient adherence to GFD or its effectiveness on villous atrophy.
  
  
  OBJECTIVE
  To assess, in a prospective study, patient adherence to and efficacy of GFD on histological recovery after 1-year of GFD.
  
  
  METHODS
  Between 2009 and 2012, we enrolled 65 consecutive newly-diagnosed adult patients (median age 38 years, 18-70) with biopsy-proven atrophic CD. Patients were re-evaluated after 1 year of GFD with duodenal histology, serological assays, symptoms and a dietary interview based on a validated questionnaire. Complete histological recovery was defined as the absence of villous atrophy and ≤30/100 intraepithelial lymphocytes.
  
  
  RESULTS
  Overall, 81.5% of patients had adequate adherence (ADA) to GFD, whereas 18.5% had an inadequate adherence (IADA); 66% of ADA patients and no IADA patients achieved complete histological recovery (P < 0.00001). Among ADA patients, antibody seroconversion and symptoms were not significantly different between patients who achieved complete histological recovery and those who achieved partial histological recovery with P = 0.309 and P = 0.197, respectively. Multivariate analysis showed that Marsh 3C was a risk factor for incomplete histological recovery in ADA patients (OR 8.74, 95% CI: 1.87-40.83).
  
  
  CONCLUSIONS
  This study shows that complete histological recovery after 1-year of GFD in adult patients, who are assessed as adherent to the GFD, can be obtained in 66% of patients. Patients with severe histological damage at diagnosis are at risk for incomplete histological recovery 1 year later.
authors: Department of Digestive and Liver Disease, Sant'Andrea Hospital, Sapienza University Rome, Rome, Italy.
authors: G
authors: G
authors: Galli
authors: G
authors: G
authors: Esposito
authors: E
authors: E
authors: Lahner
authors: E
authors: E
authors: Pilozzi
authors: V D
authors: VD
authors: Corleto
authors: E
authors: E
authors: Di Giulio
authors: M A
authors: MA
authors: Aloe Spiriti
authors: B
authors: B
authors: Annibale
mesh_terms: D000328:Adult; D001284:Atrophy / Q000178:diet therapy / Q000473:pathology; D001706:Biopsy; D002446:Celiac Disease / Q000178:diet therapy* / Q000473:pathology; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D011795:Surveys and Questionnaires