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Duodenal Histology in Patients with Celiac Disease after Treatment with a Gluten-free Diet

Celiac.com 2/13/2003 - This new study emphasizes the importance of following a strict gluten-free diet, and getting regular follow-up biopsies after your diagnosis. It also speaks to the need to discover whether or not you may have additional food intolerance, such as to cows milk (casein), soy, corn, etc., as some of these can also cause intestinal damage similar to that of celiac disease. -Scott Adams


Lee SK, Lo W, Memeo L, Rotterdam H, Green PH.
Gastrointest Endosc 2003 Feb;57(2):187-91

Current affiliations: Department of Surgical Pathology and Medicine, Columbia University College of Physicians and Surgeons, New York, New York.

BACKGROUND: The diagnosis of celiac disease requires characteristic histopathological changes in an intestinal biopsy with clinical improvement in response to a gluten-free diet. Endoscopy with procurement of biopsy specimens is often performed to document response to the diet, but there are little data on the appearance of treated celiac disease. This study examined the endoscopic and histopathological appearance of the duodenum of patients with celiac disease whose diet was gluten-free.

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METHODS: A cohort of 39 adult patients (mean age 52 years, range 20-74 years) with biopsy-proven celiac disease was retrospectively reviewed. All had responded clinically to a gluten-free diet that they had maintained for a mean of 8.5 years (range 1-45 years). The endoscopic and histopathological appearances of the duodenal mucosa were reviewed. Blinded review of the diagnostic (initial) and post-treatment biopsy specimens was also performed to assess response of individual patients to the diet.

RESULTS: The endoscopic appearance was normal in 23%, reduced duodenal folds were present in 46%, scalloping of folds in 33%, mucosal fissures in 44%, and nodularity in 33%. There was more than 1 abnormality present in 46%. Histology was normal in only 21%. The remainder had villous atrophy (69% partial, 10% total). Paired (diagnostic and follow-up) biopsy specimens were reviewed blindly for 12 patients. The mean (SD) intraepithelial lymphocyte count fell from 61 (22) to 38 (17) (normal <30 per 100 epithelial cells) and the crypt-to-villous ratio improved although it did not normalize.

CONCLUSIONS: Despite a good clinical response, abnormal endoscopic and histopathological appearances persist in the majority of patients with celiac disease treated with a gluten-free diet.

PMID: 12556782

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Thank you so much, I will be making a doctors appointment soon

Many of us are lactose intolerant at the beginning (damaged villi tips can not release the enzymes to digest lactose), so experient. Choose lactose low foods like hard cheeses and yogurts. If she has no issues, add in milk and ice cream. Leafy greens are great sources of calcium too. Make sur...

Your doctor is wrong, you should be getting an annual test to see if you are doing well. This is standard care for celiacs. Learn more: http://www.cureceliacdisease.org/faq/how-often-should-follow-up-testing-occur/ By checking your celiac antibodies, you can determine if celiac disea...

If you had a celiac blood test done that showed high at diagnosis then I believe you are supposed to test at the 3 month then 1 year mark to verify that those numbers went to normal levels on a gluten free diet. If they are still high you might not be as gluten free as you thought or just going g...

You can always just sub regular milk for the powdered and liquid. Powdered milk is nice if you are using a bread maker and setting up the night before or storing a dry mix to save time. It is nice to have powdered milk on hand for earthquakes. I had to drink it as a kid. It was cheap and...