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Celiac Disease with Mild Enteropathy is Not Mild Disease

Celiac.com 03/20/2013 - People with celiac disease all have some degree of damage to the small intestinal mucosa, ranging from lymphocytic duodenosis with normal villous structure to severe villous atrophy.

To determine whether the severity of mucosal lesions was associated with clinical and laboratory features of celiac disease, a team of researchers recently conducted a study on celiac disease with mild enteropathy.

Photo: CC--benchiladaThe researchers included B. Zanini, F. Caselani, A. Magni, D. Turini, A. Ferraresi, F. Lanzarotto, V. Villanacci, N. Carabellese, C. Ricci, A. Lanzini. They are affiliated with the Gastroenterology Unit at the University of Brescia in Brescia, Italy.

For their study, they compared demographic, clinical, and laboratory characteristics among patients with celiac disease who were classified based on the severity of duodenal lesions.

The team assessed data from 1408 adult celiac patients seen consecutively at an outside referral center since 1990. 1249 patients showed villous atrophy, while 159 showed mild enteropathy (n = 159).

Patients with villous atrophy, compared with mild enteropathy, showed similar rates of weight loss (17% vs 17%), gastrointestinal manifestations (70% vs 70%), extra-intestinal manifestations (66% vs 57%), and other associated conditions (19% vs 23%).

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Patients with villous atrophy more commonly developed osteopenia or osteoporosis than patients with mild enteropathy (22% vs 5%; P = .0005).

Compared to those with mild enteropathy, patients with villous atrophy had higher rates of anemia (42% vs 29%; P = .002), folate deficiency (75% vs 64%; P = .02), hypocholesterolemia (7% vs 2%; P = .02), hypocalcemia (26% vs 13%; P = .004), or hyperparathyroidism (45% vs 29%; P = .004).

Although osteopenia, osteoporosis, and test results that fall outside of laboratory parameters are common among celiac disease patients with mild enteropathy, they are more common and more severe in patients with villous atrophy.

Patients with villous atrophy and those with mild enteropathy showed similar rates of celiac-associated conditions. These results indicate that celiac disease with mild enteropathy is not mild disease, and definitely requires treatment with a gluten-free diet.

What do you think? Do you have celiac disease with mild enteropathy? Do you consider this to be a 'mild' condition? Share your comments below.

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3 Responses:

 
LYNN HADDON
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said this on
25 Mar 2013 5:09:22 PM PDT
How does this "mild enteropathy" fit into the 4 classes of celiac disease? I was told by Dr. Fassano that I have class 3 celiac disease.

 
Waitinggame
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said this on
26 Mar 2013 5:55:55 PM PDT
Agreed! That's like saying you have stage 2 lung cancer that's "mild" because it's not stage 4, but it's still cancer! I think there's a stigma around mild celiac that seems to imply you don't need to be as strict with a gluten-free diet, when really it's just as important as anyone with damage.

 
Heather treffers
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said this on
18 Sep 2013 5:55:17 AM PDT
I have marsh 2, no antibodies. 10 years ago.. It was marsh 1. Then I had a lot of pain ago. 10 years later all my vitamins run out. I could not function anymore, feeling like a zombie. I also have dermatitis herpetiformis. I am know on a gluten free diet, but it Will take long before I will be better again, still tired but slowly getting a little bit better. Please investigate this condition more!
I don't have the normal genes. My Son also has celiac, he was diagnosed at 7. First the doctor called my condition gluten sensitivity, but have DF also, so it makes it celiac.




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Celiac.com Celiac Disease & Gluten-Free Diet Forum - All Activity

Hey All, I was wondering if anyone has tried gluten free pizza? I'm specifically talking about the store bought kind. I'm looking for a cheat meal - I've been eating mainly non processed fresh food but I need a little something to stay sane every now and then. I'm from New York so i'd say I have a pretty high standard of pizza lol. Are there any good frozen ones that are worth eating? I don't think i've ever eaten a frozen pizza in my life but I don't particularly have the time right now to make my own. Also while I'm posting I figure i'll ask. I'm going to this event with my friend at her work. It's like a dinner party. How do I navigate this situation food wise? Should I just eat at home and get drinks there or plan to eat there but take snacks just in case nothing seems safe? Thanks guys!

Hi Dalek, JMG has it right, any food with wheat, rye or barley is a gluten containing food. In addition, watch out for malt, which is sometimes made from barley. That includes the malt in beers.

Interesting!! I'm going to share that with her dr. I'll have to look into the gluten sensitivity more myself, the main reason we started testing is due to poor growth. As I learned more, I've seen several symptoms that could be explained by celiac. I like feeling informed so I'll know what to talk to the dr about or ask about. I think those are the results we are waiting for still, I couldn't remember the name.

Call your doctor's office and ask them to relay your request to the doctor to amend the test request, they should be able to sort it without an additional meeting and delay. Worth a try anyway I think the Biocard tests TTG IGA and it may give you an indication. Do post your results here as I'm sure others will be interested in its effectiveness. If it's negative however remember that there are several celiac tests for a reason. Some test on one, some on another etc... However my guess is your doctor will dismiss them and want their own testing. That's the usual experience.

Waiting for the EMA, I bet. Keep advocating! this is interesting. If celiac disease is excluded, she might still have a gluten sensitivity. There just is not specific test for that. http://theglutensummittranscripts.s3.amazonaws.com/Dr_Umberto_Volta.pdf