title: Long-term mucosal recovery and healing in celiac disease is the rule - not the exception.
abstract: OBJECTIVE
  The prevalence of persistent villous atrophy (VA) in patients with celiac disease (CD) on a gluten-free diet (GFD) varies greatly between studies. Most studies show a relatively high prevalence of mucosal atrophy and inflammation in treated patients, a finding which have led to a concept of non-responsive CD. Few studies have examined the prevalence of long-term mucosal healing. Our study aimed to determine the extent of mucosal healing in a cohort of Norwegian patients with CD treated with GFD for several years.
  
  
  METHODS
  Adult patients diagnosed with VA between 1989 and 2009 were included. We performed a follow-up gastroscopy with duodenal biopsies. Two pathologists evaluated the biopsies according to the Marsh-Oberhuber classification. Mucosal healing was defined as Marsh 0 while mucosal recovery was defined as Marsh 0-2.
  
  
  RESULTS
  Duodenal biopsies were obtained from 127 adult patients with established CD. After a follow-up time of 8.1 years (median, range 2.3-22.3), 103 (81%) of the patients showed mucosal healing, 120 patients (94%) showed mucosal recovery, and 7 patients (6%) showed persistent VA. In addition, 103 of the 127 patients (81%) had undergone a routine follow-up biopsy 12.6 months (median, range 5.2-28.8) after diagnosis. At the time of the routine follow-up, only 52 of these patients (50.5%) had achieved mucosal recovery.
  
  
  CONCLUSIONS
  Although half of the patients had persistent VA at the time of routine follow-up, both long-term mucosal recovery and healing is possible for the vast majority of adult patients with CD.
authors.affiliation: a Department of Gastroenterology , Sørlandet Hospital HF , Arendal , Norway.
authors.forename: Petter
authors.initials: P
authors.lastname: Hære
authors.affiliation: a Department of Gastroenterology , Sørlandet Hospital HF , Arendal , Norway.
authors.forename: Ole
authors.initials: O
authors.lastname: Høie
authors.affiliation: a Department of Gastroenterology , Sørlandet Hospital HF , Arendal , Norway.
authors.forename: Tom
authors.initials: T
authors.lastname: Schulz
authors.affiliation: b Department of Pathology , Sørlandet Hospital HF , Kristiansand , Norway.
authors.forename: Irina
authors.initials: I
authors.lastname: Schönhardt
authors.affiliation: c Department of Pathology , Oslo University Hospital , Oslo , Norway.
authors.forename: Melinda
authors.initials: M
authors.lastname: Raki
authors.affiliation: d CIR - Centre for Immune Regulation in Oslo, Oslo University Hospital, University of Oslo , Oslo , Norway.
authors.forename: Knut E A
authors.initials: KE
authors.lastname: Lundin
mesh_terms: D000328:Adult; D000368:Aged; D001284:Atrophy / 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; D005773:Gastroscopy; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009664:Norway; D014945:Wound Healing
keywords: Celiac disease; endoscopy general; gastroduodenal clinic; malabsorption mucosal function; nutrition; small intestinal disorders