Splenic atrophy in adult coeliac disease: is it reversible?

Abstract

SUMMARY A study of splenic function in 28 patients with adult coeliac disease showed no significant correlation between the half life of heat-damaged red cells and either the duration of pre-treatment exposure to gluten or the length of time on a gluten free diet. A significant correlation was found between splenic size and duration of treatment; those patients who had been taking a gluten free diet for the longest time had the smallest spleens. Blood films from 11 of these 28 patients taken before treatment with a gluten free diet were compared with those taken between two and 15 years after the start of treatment. There was no tendency for the hyposplenic changes to regress. In the majority, the changes became more prominent despite strict adherence to the gluten free diet. These findings suggest that splenic atrophy in adult coeliac disease is not reversed by treatment with a gluten free diet and is unlikely to be related to the state of the jejunal mucosa or the duration of initial exposure to gluten.Splenic atrophy is now widely recognised as an accompaniment of adult coeliac disease. It has been demonstrated using quantitative techniques such as measuring the half life of heat-damaged red cells and splenic size as defined by area of radioactivity on a rectilinear scan.' The recognition of the changes in red cell morphology characteristic of hyposplenism may first alert the physician to the possibility that the patient has adult coeliac disease.6The mechanism of splenic atrophy is not known. In inflammatory bowel disease, where splenic atrophy may also occur, improvement in splenic function may follow excision of the diseased bowel.7 However, in coeliac disease the small intestinal lesion is presumed to develop in early childhood after weaning onto gluten containing foods. Even if the hyposplenism were related to the mucosal lesion, the factors determining hyposplenism could have been operating long enough to produce irreversible changes by the time a gluten free diet is started in adult life.In this study we have examined the serial changes in red cell morphology which occur when patients with adult coeliac disease are treated with a gluten free diet. In patients already taking a gluten free diet we

Hematologic manifestations of celiac disease

“…Other investigations have not supported this and have, on the contrary, suggested that splenic hypofunction may be irreversible in adult patients with CD. 114 Hyposplenism appears to be much less common in children with CD, as reported by Corazza et al 115 In their report of 37 children with CD, none were found to have the elevated pitted-erythrocyte count suggestive of hyposplenism. Various autoantibodies including antinuclear antibodies, anti-smooth-muscle antibodies, and antimitochondrial antibodies have been found in patients with CD and hyposplenism.…”

Risk of morbidity in contemporary celiac disease

“…Hyposplenism appears to be much less common in children with celiac disease [137,142,143,146], with duration of exposure to gluten as a significant factor for the prevalence and severity of the hyposplenism [138]. Adherence to a gluten-free diet was associated with a decrease in pitted red blood cells, suggesting hyposplenism may be reversible [136], but this observation is not supported by other investigators [147]. Higher pitted red blood cell counts were also observed in those with more severe duodenal histology [143] or with complicated celiac disease such as jejunoileitis [140].…”

“…Hyposplenism, which may be a complication of chronic folate deficiency, the result of excessive loss of lymphocytes through the damaged GI tract or related to the mucosal lesion [135], is a well-documented complication of celiac disease in historical case series [136][137][138][139][140][141][142][143][144][145][146][147]. Hyposplenism appears to be much less common in children with celiac disease [137,142,143,146], with duration of exposure to gluten as a significant factor for the prevalence and severity of the hyposplenism [138].…”

Systematic review: the evidence base for long‐term management of coeliac disease

“…Increased sexual activity and satisfaction 263, 264, 268, 274, 275, 277-279, 283, 351 Reduced rates of infertility, miscarriage, intrauterine growth restriction and low birth weight 263, 264, 268, 274, 275, 277-279, 283, 351 Undiagnosed CD may be a risk factor for unfavourable foetal outcome 276 Cardiac disease Improvement in myocarditis and dilated cardiomyopathy 318,355,356 Hyposplenism Functional hyposplenism may be reversible 353 Splenic atrophy usually irreversible 354 …”