Gluten tolerance in adult patients with celiac disease 20 years after diagnosis?

Hopman, Erica; Blomberg, Mary E. von; Batstra, Manou R.; Morreau, Hans; Dekker, Friedo W.; Koning, Frits; Lamers, Cor B.H.W.; Mearin, M. Luisa

doi:10.1097/meg.0b013e3282f4de6e

Cited by 27 publications

(22 citation statements)

References 38 publications

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“…Sixty percent of participating CD patients continued to have symptoms while on a GFD, a phenomenon also described by others [22,23] (Hopman et al, unpublished observations [24]). These symptoms may be related to CD in combination with extreme sensitivity to trace amounts of gluten or to intentional or unintentional lapses in the GFD, but our study was not designed to distinguish between underlying factors for these symptoms.…”

Section: Discussionsupporting

confidence: 66%

Tef in the diet of celiac patients in The Netherlands

Hopman

Dekking

Blokland

et al. 2008

Scandinavian Journal of Gastroenterology

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Section: Discussionsupporting

confidence: 66%

Tef in the diet of celiac patients in The Netherlands

Hopman

Dekking

Blokland

et al. 2008

Scandinavian Journal of Gastroenterology

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“…Interestingly, 4 patients with poor adherence to GFD achieved mucosal recovery, suggesting that the development of tolerance to gluten may be possible in some adults with biopsy-proven CD; 53–55 however, clinical or histological relapse of the disease (in some cases with a different phenotype) or complications may still occur over time 54, 56…”

Section: Discussionmentioning

confidence: 99%

Mucosal Recovery and Mortality in Adults With Celiac Disease After Treatment With a Gluten-Free Diet

Rubio–Tapia

Rahim

See

et al. 2010

American Journal of Gastroenterology

352

309

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Objectives-Clinical response is typically observed in most adults with celiac disease (CD) after treatment with a gluten-free diet (GFD). The rate of mucosal recovery is less certain. The aims of this study were 1) to estimate the rate of mucosal recovery after GFD in a cohort of adults with CD, and 2) to assess the clinical implications of persistent mucosal damage after GFD.Methods-The study group included adults with biopsy-proven CD evaluated at the Mayo Clinic who had duodenal biopsies at diagnosis and at least one follow-up intestinal biopsy to assess mucosal recovery after starting a GFD. The primary outcomes of interest were mucosal recovery and all-cause mortality.Results-Of 381 adults with biopsy-proven CD, 241 (73% females) had both a diagnostic and follow-up biopsy available for re-review. Among these 241, the Kaplan-Meier rate of confirmed mucosal recovery at 2 years following diagnosis was 34% (95% CI: 27%-40%), and at 5 years was 66% (95% CI: 58%-74%). Most patients (82%) had some clinical response to GFD, but it was not a reliable marker of mucosal recovery (p=0.7). Serological response was associated with confirmed mucosal recovery (p=0.01). Poor compliance to GFD (p<.01), severe CD defined by diarrhea and weight loss (p<.001), and total villous atrophy at diagnosis (p<.001) were strongly associated with persistent mucosal damage. There was a trend toward an association between achievement of mucosal recovery and a reduced rate of all-cause mortality (HR = 0.13, 95% CI: 0.02-1.06, p = .06), adjusted for gender and age.Conclusions-Mucosal recovery was absent in a substantial portion of adults with CD after treatment with a GFD. There was a borderline significant association between confirmed mucosal recovery (vs. persistent damage) and reduced mortality independent of age and gender. Systematic follow-up with intestinal biopsies may be advisable in patients diagnosed with CD as adults.

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“…Some concern could be raised about the benefit of blocking lymphocyte homing to the intestine, and potential long-term adverse consequences, also because beneficial immunosuppressive regulatory T cells are equally inhibited. Since its demonstration, the possibility to develop tolerance to gluten in certain patients affected by celiac disease has gained more attractiveness as another potential immunomodulatory approach[116,117]. An alternative method studied for induction of tolerance to gluten is oral administration of a genetically modified Lactococus lactis bacterium, capable of secreting deamidated DQ8-restricted gliadin epitope.…”

Section: Current Treatments Of Celiac Diseasementioning

confidence: 99%

Celiac disease: From pathophysiology to treatment

Parzanese

Qehajaj

Patrinicola

et al. 2017

WJGP

220

169

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Celiac disease, also known as “celiac sprue”, is a chronic inflammatory disorder of the small intestine, produced by the ingestion of dietary gluten products in susceptible people. It is a multifactorial disease, including genetic and environmental factors. Environmental trigger is represented by gluten while the genetic predisposition has been identified in the major histocompatibility complex region. Celiac disease is not a rare disorder like previously thought, with a global prevalence around 1%. The reason of its under-recognition is mainly referable to the fact that about half of affected people do not have the classic gastrointestinal symptoms, but they present nonspecific manifestations of nutritional deficiency or have no symptoms at all. Here we review the most recent data concerning epidemiology, pathogenesis, clinical presentation, available diagnostic tests and therapeutic management of celiac disease.

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Gluten tolerance in adult patients with celiac disease 20 years after diagnosis?

Cited by 27 publications

References 38 publications

Tef in the diet of celiac patients in The Netherlands

Tef in the diet of celiac patients in The Netherlands

Mucosal Recovery and Mortality in Adults With Celiac Disease After Treatment With a Gluten-Free Diet

Celiac disease: From pathophysiology to treatment

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