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    Jefferson Adams

    Mucosal Recovery and Mortality in Adults With Celiac Disease After Treatment With a Gluten-Free Diet

    Jefferson Adams
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    Reviewed and edited by a celiac disease expert.

    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.



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    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

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    I was diagnosed with celiac disease at age 62 [with biopsy] and have followed a gluten free diet strictly for 6 years but I still have lots of gastric intestinal problems. I have read that after 5 years on the diet, mucosal recovery should be complete. This article confirms what I have suspected, that complete mucosal recovery does not happen for everyone. It also encourages me to seek a knowledgeable specialist for follow-up evaluation. Thanks for the latest clinical information.

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    I was diagnosed with celiac disease at age 62 [with biopsy] and have followed a gluten free diet strictly for 6 years but I still have lots of gastric intestinal problems. I have read that after 5 years on the diet, mucosal recovery should be complete. This article confirms what I have suspected, that complete mucosal recovery does not happen for everyone. It also encourages me to seek a knowledgeable specialist for follow-up evaluation. Thanks for the latest clinical information.

    I would continue to read and investigate other issues as well. I was diagnosed with celiac disease 18 months ago. when I first went gluten free I could not believe how much better I felt, but continued to have issues with digestion. The doctor had advised me that lactose might become an issue, but I really resisted going off milk, it was much harder than going off gluten! I tried lactose free, without much difference. Dr told me then that it was not lactose but casein, a protein in milk that is very similar to gluten. I have made a monumental effort to not do dairy and things are finally starting to feel "normal". most days. ha ha - good luck.

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  • About Me

    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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