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Complete histological recovery is possible with gluten-free diet adherence in celiac disease

A prospective study of adult patients with celiac disease reported in the Alimentary Pharmacology & Therapeutics examines histological recovery and gluten-free diet adherence.

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Adequate gluten-free diet is the only treatment for celiac disease.

However, no agreement has been reached on either how and when to assess patient adherence to gluten-free diet or its effectiveness on villous atrophy.

Professor Annibale and colleagues from Italy assessed, in a prospective study, patient adherence to, and efficacy of gluten-free diet on histological recovery after 1-year of gluten-free diet.

Between 2009 and 2012, the team enrolled 65 consecutive newly-diagnosed adult patients with biopsy-proven atrophic celiac disease.

Patients were re-evaluated after 1 year of gluten-free diet with duodenal histology, serological assays, symptoms and a dietary interview based on a validated questionnaire.

82% of patients had adequate adherence to gluten-free diet
Alimentary Pharmacology & Therapeutics

Complete histological recovery was defined as the absence of villous atrophy and ≤30/100 intraepithelial lymphocytes.

Overall, 82% of patients had adequate adherence to gluten-free diet, whereas 19% had an inadequate adherence.

The team observed that 66% of adequate adherence patients, and no IADA patients achieved complete histological recovery.

Among adequate adherence patients, antibody seroconversion and symptoms were not significantly different between patients who achieved complete histological recovery, and those who achieved partial histological recovery, respectively.

The research team showed that Marsh 3C was a risk factor for incomplete histological recovery in adequate adherence patients.

Professor Annibale's team concludes, "This study shows that complete histological recovery after 1-year of gluten-free diet in adult patients, who are assessed as adherent to the gluten-free diet, can be obtained in 66% of patients."

"Patients with severe histological damage at diagnosis are at risk for incomplete histological recovery 1 year later."

Aliment Pharmacol Ther 2014: 40(6): 639–647
04 September 2014

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