Duodenal injury persists in some celiac disease patients despite gluten-free diet, and is associated with adverse outcomes.
Dr Adelman and colleagues from California, USA determined the prevalence and clinical risk factors for persistent villus atrophy among symptomatic celiac disease patients.
The researchers performed a nested cross-sectional analysis on celiac disease patients with self-reported moderate or severe symptoms while following a gluten-free diet, who underwent protocol-mandated duodenal biopsy upon enrolment in the CeliAction clinical trial.
Demographic factors, symptom type, medication use, and serology were examined to determine predictors of persistent villus atrophy.
|38% were found to have active celiac disease with persistent villus atrophy|
|Alimentary Pharmacology & Therapeutics|
Of 1345 symptomatic patients, 38% were found to have active celiac disease with persistent villus atrophy, defined as average villus height to crypt depth ratio ≤2.0.
The researchers found that older age was a risk factor while longer duration on gluten-free diet was protective.
The team noted that villus atrophy was associated with use of proton-pump inhibitors, non-steroidal anti-inflammatory drugs, and selective serotonin reuptake inhibitors.
Symptoms were not associated with villus atrophy after adjusting for covariates.
Dr Adelman's team concludes, "A majority of symptomatic celiac disease patients did not have active disease on follow-up histology."
"Symptoms were poorly predictive of persistent mucosal injury."
"The impact of NSAIDs, PPIs, and SSRIs on mucosal healing in coeliac disease warrants further study."