Histologic Follow-up of People With Celiac Disease on a Gluten-Free Diet

Abstract

To assess histologic recovery in response to gluten withdrawal in celiac disease, 158 patients seen in our hospital during a 15-year period underwent follow-up small intestine biopsies (SIBs) within 2 years after starting a gluten-free diet; further SIBs were done if villous atrophy was present. A modified Marsh classification was used (IIIA, partial villous atrophy; IIIB, subtotal villous atrophy; IIIC, total villous atrophy). Of patients with Marsh IIIA, IIIB, or IIIC lesions, histologic remission was seen in 65.0% within 2 years, 85.3% within 5 years, and 89.9% in long-term follow-up. Eleven patients (7.0%) with persisting (partial) villous atrophy had symptoms and signs of malabsorption and were considered to have refractory celiac disease; 5 of them developed an enteropathy-associated T-cell lymphoma. Children recovered up to 95% within 2 years and 100% in the long-term. Histologic recovery in celiac disease after starting a gluten-free diet takes time and is incomplete or absent in a substantial subgroup of patients (10.1% villous atrophy after 5 years). Systematic follow-up of patients with celiac disease and the malabsorption syndrome and secondary complications is needed.

Involvement of macrophage migration inhibitory factor gene in celiac disease susceptibility

“…[18][19][20] Our data suggest that the reported MIF levels would not be a consequence of the inflammatory process, but they would be directly involved in the etiology of the disease. Functional studies on the role of the polymorphisms tested have been performed in the past with controversial findings reported in different cell types; [21][22][23] however, the (CAAT) 5 allele was associated with reduced basal and serum/forskolin-stimulated transcriptional activity in vitro [21][22][23] and the (CAAT) 7 and À173C alleles emerged as probable upregulators of transcriptional activity.…”

Celiac disease in Brazilian patients: associations, complications and causes of death. Forty years of clinical experience

“…They must recommend a strict adherence to a GFD for patients with CD, and be aware of the appearance of autoimmune diseases (67) . In addition, professionals should re-study the patients with different symptoms or clinical deterioration with the objective of an early diagnosis of malignancies (72) .…”

“…It should be noted that histological recovery after starting a GFD takes time (more than 2 years in 35% of the patients) and that 10% of the patients present incomplete or non recovery. The risk of this group of patients developing a malignant neoplasma is undefined thus far, and should be further investigated (72) .…”

Age-related differences in celiac disease: Specific characteristics of adult presentation

“…Recent studies have shown that more than 50% of adults do not recover from villous atrophy, even after two years on a proper diet [32] . In the case of children, even though information is limited, there is duodenal mucosa recovery in the vast majority (95%) during the first two years after the diagnosis [33] . The main cause of this lack of mucosal recovery in adults could be the continuous and inadvertent ingestion of small amounts of gluten.…”