title: Persistent Intraepithelial Lymphocytosis in Celiac Patients Adhering to Gluten-Free Diet Is Not Abolished Despite a Gluten Contamination Elimination Diet.
abstract: The gluten-free diet (GFD) is the only validated treatment for celiac disease (CD), but despite strict adherence, complete mucosal recovery is rarely obtained. The aim of our study was to assess whether complete restitutio ad integrum could be achieved by adopting a restrictive diet (Gluten Contamination Elimination Diet, GCED) or may depend on time of exposure to GFD. Two cohorts of CD patients, with persisting Marsh II/Grade A lesion at duodenal biopsy after 12-18 months of GFD (early control) were identified. Patients in Cohort A were re-biopsied after a three-month GCED (GCED control) and patients in Cohort B were re-biopsied after a minimum of two years on a standard GFD subsequent to early control (late control). Ten patients in Cohort A and 19 in Cohort B completed the study protocol. There was no change in the classification of duodenal biopsies in both cohorts. The number of intraepithelial lymphocytes, TCRγδ+ (T-Cell Receptor gamma delta) T cell and eosinophils significantly decreased at GCED control (Cohort A) and at late control (Cohort B), compared to early control. Duodenal intraepithelial lymphocytosis persisting in CD patients during GFD is not eliminated by a GCED and is independent of the length of GFD. [NCT 02711696].
authors: Gastroenterology Unit, University and Spedali Civili of Brescia, Piazzale Spedali Civili, Brescia I-25123, Italy. barbara.zanini@unibs.it.
authors: Barbara
authors: B
authors: Zanini
authors: Gastroenterology Unit, University and Spedali Civili of Brescia, Piazzale Spedali Civili, Brescia I-25123, Italy. mon.ya@live.it.
authors: Monica
authors: M
authors: Marullo
authors: Histopathology Unit, University and Spedali Civili of Brescia, Piazzale Spedali Civili, Brescia I-25123, Italy. villanac@alice.it.
authors: Vincenzo
authors: V
authors: Villanacci
authors: Histopathology Unit, University and Spedali Civili of Brescia, Piazzale Spedali Civili, Brescia I-25123, Italy. mariannasalemme@alice.it.
authors: Marianna
authors: M
authors: Salemme
authors: Gastroenterology Unit, University and Spedali Civili of Brescia, Piazzale Spedali Civili, Brescia I-25123, Italy. francesco.lanzarotto@asst-spedalicivili.it.
authors: Francesco
authors: F
authors: Lanzarotto
authors: Gastroenterology Unit, University and Spedali Civili of Brescia, Piazzale Spedali Civili, Brescia I-25123, Italy. chiara.ricci@unibs.it.
authors: Chiara
authors: C
authors: Ricci
authors: Gastroenterology Unit, University and Spedali Civili of Brescia, Piazzale Spedali Civili, Brescia I-25123, Italy. alberto.lanzini@unibs.it.
authors: Alberto
authors: A
authors: Lanzini
mesh_terms: D000328:Adult; D001284:Atrophy; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis / Q000178:diet therapy* / Q000473:pathology; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000473:pathology*; D005260:Female; D005506:Food Contamination; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008218:Lymphocytosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: celiac disease; gluten contamination; gluten free diet; mucosal recovery