title: Beneficial effects of gluten free diet in potential coeliac disease in adult population.
abstract: BACKGROUND
  To date, potential coeliac disease (PCD) occurring in adults remains an almost unexplored condition.
  
  
  OBJECTIVE
  To explore the prognostic role of Marsh grade in adult PCD patients, and to evaluate the effects of gluten-containing diet (GCD) in asymptomatic PCD patients.
  
  
  METHODS
  We retrospectively evaluated all consecutive adult PCD patients followed-up for at least 6 years. Patients were divided into: Group A (patients with Marsh 0 histology) and Group B (Marsh 1 patients). Symptomatic patients were started gluten-free diet (GFD), while asymptomatic subjects were kept on GCD and were followed-up.
  
  
  RESULTS
  56 PCD patients were enrolled (21 in Group A and 35 in Group B). Forty-three patients were symptomatic and started GFD. Of these, none of 15 patients in Group A and 8 of 28 patients in Group B developed immune-mediated disorders (IMD) during follow-up (P=0.03; OR=4.2). The 13 asymptomatic PCD patients were kept on GCD. During the follow-up, 9 patients developed CD-related symptoms, 6 villous atrophy and 8 IMD. At the end, patients kept on GCD were at higher risk of developing IMD than those following a GFD (61% vs 18%, P=0.03, OR=3.3).
  
  
  CONCLUSIONS
  Although PCD with normal mucosa seems to be a milder disease, the continuation of GCD places patients at a high risk of developing villous atrophy and IMD compared to commencement of GFD. Adult PCD patients should start GFD even if not symptomatic.
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy. Electronic address: nicola.imperatore@alice.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Imperatore
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Tortora
authors.affiliation: Surgery and Advanced Endoscopy, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy.
authors.forename: Giovanni Domenico
authors.initials: GD
authors.lastname: De Palma
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Capone
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Gerbino
authors.affiliation: Department of Education and Professional Studies, King's College London, London, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: Donetto
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Testa
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Caporaso
authors.affiliation: Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rispo
mesh_terms: D000293:Adolescent; D000328:Adult; D001284:Atrophy / Q000139:chemically induced; D002446:Celiac Disease / Q000178:diet therapy* / Q000473:pathology; D055050:Diet, Gluten-Free; D019587:Dietary Supplements; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D007558:Italy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
keywords: Immuno-mediated disorders; Marsh; Potential coeliac disease; Villous atrophy