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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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