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  • Jefferson Adams
    Jefferson Adams

    Full Gut Recovery from Celiac Disease Can Take Up to Two Years

    Reviewed and edited by a celiac disease expert.
    Full Gut Recovery from Celiac Disease Can Take Up to Two Years - Photo: CC--Thomas Haynie
    Caption: Photo: CC--Thomas Haynie

    Celiac.com 03/14/2017 - Recent studies of adult celiacs have suggested that complete, not just partial, mucosal recovery and healing is possible, but, in many cases, may take longer than is currently understood.

    Recently Dr. Hugh James Freeman of the Department of Medicine, Gastroenterology, University of British Columbia, Vancouver, BC, Canada, conducted a study to assess healing time in celiac patients. In this study, 182 patients (60 males, 122 females) referred for evaluation of symptoms, including diarrhea and weight loss, were selected only if initial biopsies showed characteristic inflammatory changes with severe architectural disturbance.



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    All patients were treated with a strict gluten-free diet, and diet compliance was regularly monitored. Up to 90% or more of patients showed a complete mucosal response or healing, many within 6 months. However, most patients required up to 2 years for full healing and recovery to take place in the gut.

    In this evaluation, women in each of 4 different age ranges showed better mucosal response and healing than men, while elderly celiacs had lower rates overall. Such factors should be considered before labeling a patient with "non-responsive" disease.

    However, celiacs who are diagnosed later, start a gluten-free diet later, and who have inflammatory changes with persistent gut damage may be at increased risk for a later small bowel complication, including lymphoma.

    The overall good news here is that full mucosal healing can and does occur in most people with celiac disease. Some people may take longer to heal, but the evidence shows that most do eventually heal.

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    Wait ... Does this mean that someone with celiac disease can follow a strict gluten-free diet for two years and not have to worry about possible cross contamination after that? I was under the impression that just a hint of gluten in my diet will return my gut to the complete villous atrophy state instantly and that my villi would never be as strong as they once were. This article leads me to believe that information may have changed. Is that right?

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    Wait ... Does this mean that someone with celiac disease can follow a strict gluten-free diet for two years and not have to worry about possible cross contamination after that? I was under the impression that just a hint of gluten in my diet will return my gut to the complete villous atrophy state instantly and that my villi would never be as strong as they once were. This article leads me to believe that information may have changed. Is that right?

    This does not mean that you can eat gluten after recovery, only that full recovery can take up to two years for many celiacs.

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    Wait ... Does this mean that someone with celiac disease can follow a strict gluten-free diet for two years and not have to worry about possible cross contamination after that? I was under the impression that just a hint of gluten in my diet will return my gut to the complete villous atrophy state instantly and that my villi would never be as strong as they once were. This article leads me to believe that information may have changed. Is that right?

    No. If you have celiac disease, you must maintain a gluten-free diet. The study analysis means that, even on a gluten-free diet, people with celiac disease can take up to two years to see full healing in the gut. That fact may help doctors and patients adjust their expectations, and to better understand and treat celiac disease.

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    Thanks for the perspective. I can believe this as 14 months post gluten challenge, I still am not where I want to be or have been in healthier days. The One year mark clearly was not realistic for me personally. I am grateful that the joint pain has subsided and that my liver, pancreas, gallbladder have improved as bile and enzymes seem to have fired back on. I still struggle with inflammation and neuropathy so I know I have a ways to go.

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  • About Me

    Jefferson Adams

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,500 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.


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    Celiac.com 11/24/2014 - Following a strict gluten-free diet is the only way to treat celiac disease. However, researchers have been lacking clear agreement on how and when to assess gluten-free dietary adherence in celiac patients or how to determine its effectiveness on villous atrophy.
    To address this reality, a team of researches conducted a prospective study to determine patient adherence to a gluten-free diet, and its effect on histological recovery after 1-year of gluten-free diet.
    The research team included G. Galli, G. Esposito, E. Lahner, E. Pilozzi, V. D. Corleto, E. Di Giulio, M. A. Aloe Spiriti, and B. Annibale. They are variously affiliated with the Department of Digestive and Liver Disease, the Department of Haematology, the Department of Pathology, and the Department of Digestive Endoscopy at Sant'Andrea Hospital Sapienza University Rome in Rome, Italy, and with the Centro Ricerche S. Pietro, Ospedale S. Pietro in Rome, Italy.
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    They defined complete histological recovery as the absence of villous atrophy and ≤30/100 intraepithelial lymphocytes. The team found that 81.5% of patients showed adequate gluten-free diet adherence (ADA), whereas 18.5% had inadequate adherence (IADA).
    Overall, 66% of ADA patients achieved complete histological recovery, but no IADA patients recovered (P < 0.00001).
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    Lastly, patients who do not follow a gluten-free diet have no hope of making a full histological recovery.
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    Alimentary Pharmacology & Therapeutics 2014; 40(6):639-647.


    Jefferson Adams
    Celiac.com 06/08/2016 - Sometimes, certain cases can stand out and grab the attention of clinicians or researchers. Such is the case of a 62-year-old woman who was suffering from severe malabsorption, and diagnosed with celiac disease based on the findings of flat, small intestinal mucosa and HLA-DQ2 positivity, although celiac blood tests were negative.
    A team of researchers questioned the diagnosis, because the woman showed no clinical or histological improvement after a long period of strict gluten-free diet.
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    Jefferson Adams
    Celiac.com 08/05/2016 - Currently, a gluten free diet is the only option for treating celiac disease. Still, there are numerous patients who follow the diet, but do not respond fully clinically or histologically.
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    Jefferson Adams
    Celiac.com 12/12/2016 - Studies suggest that celiac disease affects about 0.5% to 1% of the North American population. There is no good screening data based on small intestinal biopsy performed during routine endoscopic evaluation.
    Researcher Hugh James Freeman, MD CM FRCPC FACP, of the Gastroenterology unit in the Department of Medicine at the University of British Columbia in Vancouver, British Columbia, recently set out to review the detection of adult celiac disease using duodenal screening biopsies over a 30-year period.
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