title: Factors associated with villus atrophy in symptomatic coeliac disease patients on a gluten-free diet.
abstract: Duodenal injury persists in some coeliac disease patients despite gluten-free diet, and is associated with adverse outcomes.
  
  
  
  To determine the prevalence and clinical risk factors for persistent villus atrophy among symptomatic coeliac disease patients.
  
  
  
  A nested cross-sectional analysis was performed on coeliac disease patients with self-reported moderate or severe symptoms while following a gluten-free diet, who underwent protocol-mandated duodenal biopsy upon enrolment in the CeliAction clinical trial. Demographic factors, symptom type, medication use, and serology were examined to determine predictors of persistent villus atrophy.
  
  
  
  Of 1345 symptomatic patients, 511 (38%, 95% CI, 35-41%) were found to have active coeliac disease with persistent villus atrophy, defined as average villus height to crypt depth ratio ≤2.0. On multivariable analysis, older age (OR, 5.1 for ≥70 vs. 18-29 years, 95% CI, 2.5-10.4) was a risk factor while longer duration on gluten-free diet was protective (OR, 0.37, 95% CI, 0.24-0.55 for 4-5.9 vs. 1-1.9 years). Villus atrophy was associated with use of proton-pump inhibitors (PPIs; OR, 1.6, 95% CI, 1.1-2.3), non-steroidal anti-inflammatory drugs (NSAIDs; OR, 1.64, 95% CI, 1.2-2.2), and selective serotonin reuptake inhibitors (SSRIs; OR, 1.74, 95% CI, 1.2-2.5). Symptoms were not associated with villus atrophy after adjusting for covariates. Conclusions A majority of symptomatic coeliac disease patients did not have active disease on follow-up histology. Symptoms were poorly predictive of persistent mucosal injury. The impact of NSAIDs, PPIs, and SSRIs on mucosal healing in coeliac disease warrants further study.
authors.affiliation: Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, USA.
authors.forename: S
authors.identifier: 0000-0002-4123-3922
authors.initials: S
authors.lastname: Mahadev
authors.affiliation: Division of Gastroenterology and Hepatology, The Mayo Clinic, Rochester, MN, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Murray
authors.affiliation: Department of Laboratory Medicine and Pathology, The Mayo Clinic, Rochester, MN, USA.
authors.forename: T-T
authors.initials: TT
authors.lastname: Wu
authors.affiliation: Department of Laboratory Medicine and Pathology, The Mayo Clinic, Rochester, MN, USA.
authors.forename: V S
authors.initials: VS
authors.lastname: Chandan
authors.affiliation: Department of Laboratory Medicine and Pathology, The Mayo Clinic, Rochester, MN, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Torbenson
authors.affiliation: Celiac Center, Beth Israel Deaconess Medical Center and Celiac Research Program, Harvard Medical School, Boston, MA, USA.
authors.forename: C P
authors.initials: CP
authors.lastname: Kelly
authors.affiliation: Tampere Center for Child Health Research, School of Medicine, University of Tampere and Tampere University Hospital, Finland, Europe.
authors.forename: M
authors.initials: M
authors.lastname: Maki
authors.affiliation: Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, USA.
authors.forename: P H R
authors.initials: PH
authors.lastname: Green
authors.affiliation: Division of Allergy/Immunology, Department of Medicine, University of California, San Francisco, CA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Adelman
authors.affiliation: Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, USA.
authors.forename: B
authors.initials: B
authors.lastname: Lebwohl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000453:epidemiology / Q000473:pathology; D001706:Biopsy; D002446:Celiac Disease / Q000178:diet therapy* / Q000453:epidemiology / Q000473:pathology*; D003430:Cross-Sectional Studies; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000473:pathology; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D014945:Wound Healing; D055815:Young Adult