Gut Damage Common, and Often Slow to Heal, Even for Gluten-Free Celiacs

Celiac.com 01/09/2019 - People with celiac disease who eat a gluten-free diet generally see an improvement in gut health over the next months and years. That’s true, but many people with celiac disease who eat a gluten-free diet still have gut damage many months later. What exactly is the connection between gut health and a gluten-free diet in people with celiac disease? 

To try to answer that question, a team of researchers recently set out to analyze the relationships between pre-diagnosis celiac serology, duodenal histopathology, primary presenting symptoms, celiac-related comorbidity and response to treatment in a modern cohort with new diagnosis of celiac disease.
 
The research team included Oliver Cronin, Emma Flanagan, and Damian Dowling. They are variously affiliated with the Department of Gastroenterology, University Hospital Geelong, in Geelong, Australia, and the Department of Gastroenterology at St Vincent’s Hospital in Fitzroy, Australia.

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The team’s retrospective cohort study included 99 participants diagnosed with celiac disease between 1999 and 2013. For each patient, the team recorded baseline characteristics, celiac serology, and small bowel histopathology. Several patients underwent a repeat small bowel biopsy. The team used logistic regression to determine independent associations.

Patients ranged from 30 to 53 years old, and averaged 43 years at diagnosis. Women made up nearly seventy percent of the group. 

The researchers used standard Marsh-Oberhuber Score (MS) to rate damage to intestinal villi. At diagnosis, nearly half of the patients showed total villous blunting (MS 3c), while twelve patients showed subtotal villous blunting (MS 3b), and 29 patients showed partial villous blunting (MS 3a). The extent of villous blunting was independent of symptom prevalence prior to diagnosis. 

A total of 87 patients received repeat small bowel biopsy at an average of 7 months after their initial biopsy. Meanwhile, a total of 34 patients had biopsy results at or above MS 3a, compared to 90 patients at the initial biopsy. 24 of the 34 patients reported following a strict a gluten free diet (GFD). 

Persistent MS at or above grade 3a at repeat biopsy was not associated with symptoms (P = 0.358) or persistent positive celiac serology.

This study shows that the severity of the small bowel mucosal lesion at celiac disease diagnosis is independent of both symptoms and serology, and that neither are good predictors of mucosal health. 

While numerous patients do see histological improvement on a gluten-free diet, many newly diagnosed celiac patients show ongoing mucosal damage after many months on a gluten-free diet. An absence of celiac disease antibodies did not preclude ongoing mucosal damage. Basically, not all celiac patients see rapid gut healing, even on a strict gluten-free diet. Also, people with celiac disease can still have mucosal damage, even if they test negative for celiac disease antibodies. 

Source:

• World J Gastrointest Pharmacol Therv.9(6); 2018