NEW YORK (Reuters Health, by Will Boggs, MD) Mar 04 - When celiac disease is diagnosed in adulthood, mucosal damage might never completely resolve, even on a gluten-free diet, according to a February 9th online report in The American Journal of Gastroenterology.
“Celiac disease is a serious inflammatory condition that does not always heal,” senior Dr. Joseph A. Murray from Mayo Clinic College of Medicine, Rochester, Minnesota told Reuters Health by email.
Dr. Murray and his colleagues analyzed mucosal recovery and all-cause mortality in 241 adults who had diagnostic and follow-up biopsies. All of the diagnostic biopsies showed some degree of intestinal villous atrophy, and nearly half the patients had total villous atrophy. The median age at diagnosis was 47 years, and all had been following - or attempting to follow—a gluten-free diet since learning of their celiac disease.
Out of 165 patients with first follow-up biopsies within two years of diagnosis, only 58 (35%) had mucosal recovery. Thirty-eight additional patients (23%) eventually did have mucosal healing, as confirmed by later biopsies.
For the entire cohort, the actuarial rate of intestinal healing at two years was 34%. At 5 years, 66% of patients had mucosal recovery. The median time to confirmed recovery was approximately 3.8 years.
Most patients (82%) had at least some clinical response to the gluten-free diet, but clinical response was not related to mucosal recovery on the first follow-up biopsy. Among the 192 patients with a complete or partial clinical response, 119 (62%) had persistent mucosal damage. (A serologic response to the diet was associated with mucosal recovery, however.)
For 236 patients, the researchers had reports from dietitians regarding gluten-free compliance. Rates of good, moderate, and poor compliance were 75%, 20% and 4%, respectively, in patients with intestinal recovery, compared to 61%, 21% and 18%, respectively, in those with persistent damage.
Seventeen patients died during the first ten years of follow-up. Eleven had at least one follow-up biopsy, and all but one still had mucosal damage in the last biopsy before death. Cancer was the most common cause of death in these patients.
The mortality rate was 87% lower with confirmed mucosal recovery versus persistent mucosal damage, although the relationship fell short of statistical significance (P=0.06).
“Systematic follow-up with intestinal biopsies may be advisable in patients diagnosed with celiac disease as adults,” the investigators conclude.
Dr. Murray recommended intestinal biopsy “after one year of gluten-free diet” and, for patients with persistent mucosal damage even on the diet, “close surveillance, follow-up with diet review, and, if symptoms are present, look for refractory change.”
Am J Gastroenterol 2010.
Reuters Health Information © 2010