Jump to content



Celiac.com Sponsor (A1):



Celiac.com Sponsor (A1-m):


  • You've found your Celiac Tribe! Join our like-minded, private community and share your story, get encouragement and connect with others.

    💬

    • Sign In
    • Sign Up
  • Record is Archived

    This article is now archived and is closed to further replies.

    Scott Adams
    Scott Adams

    Duodenal Histology in Patients with Celiac Disease after Treatment with a Gluten-free Diet

    Reviewed and edited by a celiac disease expert.

    Celiac.com 2/13/2003 - This new study emphasizes the importance of following a strict gluten-free diet, and getting regular follow-up biopsies after your diagnosis. It also speaks to the need to discover whether or not you may have additional food intolerance, such as to cows milk (casein), soy, corn, etc., as some of these can also cause intestinal damage similar to that of celiac disease. -Scott Adams



    Celiac.com Sponsor (A12):






    Celiac.com Sponsor (A12-m):





    Lee SK, Lo W, Memeo L, Rotterdam H, Green PH.
    Gastrointest Endosc 2003 Feb;57(2):187-91

    Current affiliations: Department of Surgical Pathology and Medicine, Columbia University College of Physicians and Surgeons, New York, New York.

    BACKGROUND: The diagnosis of celiac disease requires characteristic histopathological changes in an intestinal biopsy with clinical improvement in response to a gluten-free diet. Endoscopy with procurement of biopsy specimens is often performed to document response to the diet, but there are little data on the appearance of treated celiac disease. This study examined the endoscopic and histopathological appearance of the duodenum of patients with celiac disease whose diet was gluten-free.

    METHODS: A cohort of 39 adult patients (mean age 52 years, range 20-74 years) with biopsy-proven celiac disease was retrospectively reviewed. All had responded clinically to a gluten-free diet that they had maintained for a mean of 8.5 years (range 1-45 years). The endoscopic and histopathological appearances of the duodenal mucosa were reviewed. Blinded review of the diagnostic (initial) and post-treatment biopsy specimens was also performed to assess response of individual patients to the diet.

    RESULTS: The endoscopic appearance was normal in 23%, reduced duodenal folds were present in 46%, scalloping of folds in 33%, mucosal fissures in 44%, and nodularity in 33%. There was more than 1 abnormality present in 46%. Histology was normal in only 21%. The remainder had villous atrophy (69% partial, 10% total). Paired (diagnostic and follow-up) biopsy specimens were reviewed blindly for 12 patients. The mean (SD) intraepithelial lymphocyte count fell from 61 (22) to 38 (17) (normal

    CONCLUSIONS: Despite a good clinical response, abnormal endoscopic and histopathological appearances persist in the majority of patients with celiac disease treated with a gluten-free diet.

    PMID: 12556782



    User Feedback

    Recommended Comments

    There are no comments to display.



    Guest
    This is now closed for further comments

  • About Me

    Scott Adams

    Scott Adams was diagnosed with celiac disease in 1994, and, due to the nearly total lack of information available at that time, was forced to become an expert on the disease in order to recover. In 1995 he launched the site that later became Celiac.com to help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives.  He is co-author of the book Cereal Killers, and founder and publisher of the (formerly paper) newsletter Journal of Gluten Sensitivity. In 1998 he founded The Gluten-Free Mall which he sold in 2014. Celiac.com does not sell any products, and is 100% advertiser supported.


  • Celiac.com Sponsor (A17):
    Celiac.com Sponsor (A17):





    Celiac.com Sponsors (A17-m):




  • Related Articles

    Scott Adams
    Wahab PJ, Meijer JW, Mulder CJ.
    Department of Gastroenterology and Hepatology, Rijnstate Hospital Arnhem, The Netherlands.
    Am J Clin Pathol 118(3):459-463, 2002
    Celiac.com 10/28/2002 - The following study strongly supports follow-up care and testing for people with celiac disease. As the study found, over 10% of people with diagnosed celiac disease have still not fully recovered even after five years of treatment.
    To assess histologic recovery in response to gluten withdrawal in celiac disease, 158 patients seen in our hospital during a 15-year period underwent follow-up small intestine biopsies (SIBs) within 2 years after starting a gluten-free diet; further SIBs were done if villous atrophy was present. A modified Marsh classification was used (IIIA, partial villous atrophy; IIIB, subtotal villous atrophy; IIIC, total villous atrophy). Of patients with Marsh IIIA, IIIB, or IIIC lesions, histologic remission was seen in 65.0% within 2 years, 85.3% within 5 years, and 89.9% in long-term follow-up. Eleven patients (7.0%) with persisting (partial) villous atrophy had symptoms and signs of malabsorption and were considered to have refractory celiac disease; 5 of them developed an enteropathy-associated T-cell lymphoma. Children recovered up to 95% within 2 years and 100% in the long-term. Histologic recovery in celiac disease after starting a gluten-free diet takes time and is incomplete or absent in a substantial subgroup of patients (10.1% villous atrophy after 5 years). Systematic follow-up of patients with celiac disease and the malabsorption syndrome and secondary complications is needed.


    Scott Adams
    J Pediatr Gastroenterol Nutr. 2004 Feb; 38(2): 177-180
    Celiac.com 02/13/2004 - It has been determined that children with celiac disease exhibit an increased level of chromosome aberrations in peripheral blood lymphocytes, which may be a major factor in their higher risk of cancer over time. Now, a study by British and Croatian researchers has found that adherence to a gluten-free diet can actually decrease the number of chromosome aberrations in these children. The researchers compared chromosome aberrations in 17 children with celiac disease--before going gluten-free, then after a minimum 24 month gluten-free diet--and compared these results with that of 15 healthy children. They found that 12 of the 15 celiacs strictly followed the gluten-free diet, and these children had a significantly lower number of chromosome aberrations when compared with both the control group and the other three celiac children who did not follow the diet.
    The researchers conclude: "The frequency of chromosome aberrations in peripheral blood lymphocytes of patients with celiac disease decreased significantly on a gluten-free diet. We conclude that genomic instability is a secondary phenomenon, possibly caused by chronic intestinal inflammation."



    Jefferson Adams
    Celiac.com 10/13/2009 - The standard method of measuring successful observance of a gluten-free diet in patients with celiac disease is through a dietary interview performed by health professional. However, there is currently have no simple, objective method for conducting such a dietary interview.
    To address this discrepancy, a team of researchers recently designed an easy, quick questionnaire based on four simple questions which yield a five-level score (0–IV). The score provides the test individual with an indication of their compliance level.
    The research team was made up of Federico Biagi, Alida Andrealli, Paola Ilaria Bianchi, Alessandra Marchese, Catherine Klersy, and Gino Roberto Corazza.
    The team recently set out to assess the accuracy of the questionnaire. They ran the questions past 168 celiac patients, 126 females and 42 males, with a median age of 42·4 (SD 12·9) years. All subjects were allegedly following a gluten-free diet (median 82, 25th–75th percentile 50–108, range 15–389 months).
    They compared the resulting scores with the persistence of both villous atrophy and endomysial antibodies while on a gluten-free diet.  They also compared patient survival rates. Non-expert personnel interviewed patients by telephone.
    The questionnaire took less than one minute to complete. The lowest results were markedly more common among the patients with a persistence of both villous atrophy and positive endomysial antibodies. Those patients also had significantly higher rates of death overall.
    From these results, the researchers conclude that the questionnaire offers a simple, accurate way to verify compliance with a gluten-free diet for patients with celiac disease.
    Source:
    British Journal of Nutrition (2009), 102, 882–887



    Jefferson Adams
    Celiac.com 04/16/2010 - In most adults with celiac disease, clinical symptoms disappear with a gluten-free diet. However, the exact effects of a gluten-free diet on rates of mucosal recovery in adults with celiac disease is less certain.
    A group of clinicians recently set out to estimate the rate of mucosal recovery under a gluten-free diet in adult subjects with celiac disease, and to gauge the clinical prospects of ongoing mucosal damage in celiac patients following a gluten-free diet.
    The study group included: Alberto Rubio-Tapia, MD; Mussarat W. Rahim, MBBS; Jacalyn A. See , MS , RD, LD; Brian D. Lahr , MS; Tsung-Teh Wu, MD; and Joseph A. Murray, MD.
    Each patient in the study had biopsy-proven celiac disease, and was assessed at the Mayo Clinic. Also, each patient received duodenal biopsies at diagnosis. After beginning a gluten-free diet, each patient had at least one follow-up intestinal biopsy to assess mucosal recovery.
    The study team focused on mucosal recovery and overall mortality. Of 381 adult patients with biopsy-proven celiac disease, a total of 241 (175 women - 73%) had both a diagnostic and follow-up biopsy available for re-review.
    Using the Kaplan–Meier rate of confirmed mucosal recovery on these 241 patients, the study group found that 34% of patients enjoyed mucosal recovery at 2 years following diagnosis  (95% with a confidence interval (CI): 27–40 % ), and 66% of patients enjoyed mucosal recovery at 5 years (95% CI: 58–74 % ).
    More than 80% of patients showed some clinical response to the gluten-free diet, but clinical response was not a reliable marker of mucosal recovery ( P = 0.7). Serological response was, by far, the best marker for confirmed mucosal recovery ( P = 0.01).
    Patients who complied poorly with a gluten-free diet ( P < 0.01), those with severe celiac disease defined by diarrhea and weight loss ( P < 0.001), and those with total villous atrophy at diagnosis ( P < 0.001) had high rates of persistent mucosal damage.
    With adjustments for gender and age, patients who experienced confirmed mucosal recovery had lower mortality rates overall (hazard ratio = 0.13, 95 % CI: 0.02 – 1.06, P = 0.06).
    One of the most important findings from this study was that a large number of adults with celiac disease see no mucosal recovery, even after treatment with a GFD.
    Compared to those patients who suffered persistent damage, patients who experienced confirmed mucosal recovery had lower rates of mortality independent of age and gender.
    The group notes that systematic follow-up via intestinal biopsies may be advisable in patients diagnosed with celiac disease as adults.

    SOURCE: Am J Gastroenterol. 9 February 2010; doi: 10.1038/ajg.2010.10



  • Popular Now

×
×
  • Create New...