Younger age at diagnosis predisposes to mucosal recovery in celiac disease on a gluten-free diet: A meta-analysis

Abstract

Background and aimsPersistent intestinal damage is associated with higher complication rates in celiac disease. We aimed to assess the potential modifiers of mucosal recovery.Materials and methodsWe screened databases (PubMed, Embase, Cochrane Trials, and Web of Science) for papers on celiac disease. Papers discussing (1) celiac patients (2) follow-up biopsy and (3) mucosal recovery after commencement of a gluten-free diet were included. The primary outcome was to produce a comprehensive analysis of complete mucosal recovery (i.e., Marsh 0 on follow-up). We compared children’s recovery ratios to those of adults. Patients following a strict gluten-free dietary regimen were included in a subgroup. Summary point estimates, 95% confidence intervals (CIs), and 95% predictive intervals (PIs) were calculated. Heterogeneity was tested with I2-statistic. The PROSPERO registration number is CRD42016053482.ResultsThe overall complete mucosal recovery ratio, calculated from 37 observational studies, was 0.36 (CI: 0.28–0.44, PI: -0.12–0.84; I2: 98.4%, p<0.01). Children showed higher complete mucosal recovery ratio than adults (p<0.01): 0.65 (CI: 0.44–0.85, PI: -0.10–1.39; I2: 96.5%, p<0.01) as opposed to 0.24 (CI: 0.15–0.33, PI: -0.19–1.08; I2: 96.3%, p<0.01). In the strict dietary adherence subgroup, complete mucosal recovery ratio was 0.47 (CI: 0.24–0.70, PI: -0.47–1.41; I2: 98.8%, p<0.001). On meta-regression, diagnostic villous atrophy (Marsh 3) ratio (-8.97, p<0.01) and male ratio (+6.04, p<0.01) proved to be a significant determinant of complete mucosal recovery, unlike duration of gluten-free diet (+0.01, p = 0.62). The correlation between complete mucosal recovery ratio and age on diagnosis is of borderline significance (-0.03, p = 0.05).ConclusionsThere is considerable heterogeneity across studies concerning complete mucosal recovery ratios achieved by a gluten-free diet in celiac disease. Several celiac patients fail to achieve complete mucosal recovery even if a strict dietary regimen is followed. Younger age on diagnosis, less severe initial histologic damage and male gender predispose for achieving mucosal recovery.

Efficacy of a Gluten-Free Diet in the Gilles de la Tourette Syndrome: A Pilot Study

“…As confirmed by a systematic review, the risk of developing neurological complications in celiac patients is lower in children than in adults and their response to a GFD is generally quicker and stronger, probably because they have spent less of their life eating gluten [45,46].…”

Haemorheological and haemostatic alterations in coeliac disease and inflammatory bowel disease in comparison with non-coeliac, non-IBD subjects (HERMES): a case–control study protocol

“…Gluten-free diet, which is the only approved treatment of the disease, may reduce or eliminate some thrombotic risk factors (eg, consequences of malabsorption and chronic inflammation) but it is uncertain whether the thrombotic risk completely normalises 57. With respect to malabsorption, intestinal mucosa does not recover in a high fraction of patients despite a long-term strict diet, particularly in those diagnosed in the adulthood 58. Whether CeD patients after a thrombotic event would benefit from a lifelong anticoagulation therapy has remained unclear.…”

Efficacy of a Gluten-Free Diet in the Gilles de la Tourette Syndrome: A Pilot Study

“…As confirmed by a systematic review, the risk of developing neurological complications in coeliac patients is lower in children than in adults and their response to a GFD is generally quicker and stronger, probably because they have spent less of their life eating gluten [ 45 , 46 ].…”