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

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 % ).

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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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3 Responses:

 
Carole Boviall
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said this on
03 May 2010 3:45:31 AM PDT
I was diagnosed with CD 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.

 
Suzanne
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said this on
23 Aug 2010 10:16:54 PM PDT
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.

 
Mendel Claxton
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said this on
10 Dec 2010 10:01:23 AM PDT
I have been experiencing the classic symptoms of celiac disease and that article has encouraged me to get tested.




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Just watch out. I just went to the expo in Schaumburg, IL, and ended up getting glutened. I realized afterward that I ate all these samples thinking they were gluten free, and they weren't. One company was advertising some sugar, and had made some cake, but then I realized.... How do I know if this contains any other ingredients that might have gluten? Did they make it with a blender or utensils that had gluten contamination? Makes me realize the only safe things would be packaged giveaways with gluten free labeling. My fault for not thinking things through. It was just too exciting thinking i could try it all and enjoy without worry.

No fasting required for a celiac blood test unless they were checking your blood glucose levels during the same blood draw.

I wish! I got the flu this winter as well as a couple of colds. I do have 3 lids, the youngest in preschool, so there's always a lot of germs around. Lol

Hey again ? It's a start, but I so wish they'd done the whole panel. Some of us, myself included, test negative to the TTG-IgA. I was positive on the DGP only. I wonder if your insurance will only cover those 2? Regardless, get them done as soon as you can! Do you have a walk in lab where you live? If so, go tomorrow. Then you'll be a step closer to getting answers. Good luck and keep us posted!

I totally agree...this board is awesome! The people on here have been there for me through everything and it has helped so much! I don't think antihistamines would affect the test at all. I take an antihistamine daily as well for horrendous allergies.