Histological recovery and gluten‐free diet adherence: a prospective 1‐year follow‐up study of adult patients with coeliac disease

Abstract

Summary Background Adequate gluten‐free diet (GFD) is the only treatment for coeliac disease (CD). However, no agreement has been reached on either how and when to assess patient adherence to GFD or its effectiveness on villous atrophy. Aim To assess, in a prospective study, patient adherence to and efficacy of GFD on histological recovery after 1‐year of GFD. Methods Between 2009 and 2012, we enrolled 65 consecutive newly‐diagnosed adult patients (median age 38 years, 18–70) with biopsy‐proven atrophic CD. Patients were re‐evaluated after 1 year of GFD with duodenal histology, serological assays, symptoms and a dietary interview based on a validated questionnaire. Complete histological recovery was defined as the absence of villous atrophy and ≤30/100 intraepithelial lymphocytes. Results Overall, 81.5% of patients had adequate adherence (ADA) to GFD, whereas 18.5% had an inadequate adherence (IADA); 66% of ADA patients and no IADA patients achieved complete histological recovery (P < 0.00001). Among ADA patients, antibody seroconversion and symptoms were not significantly different between patients who achieved complete histological recovery and those who achieved partial histological recovery with P = 0.309 and P = 0.197, respectively. Multivariate analysis showed that Marsh 3C was a risk factor for incomplete histological recovery in ADA patients (OR 8.74, 95% CI: 1.87–40.83). Conclusions This study shows that complete histological recovery after 1‐year of GFD in adult patients, who are assessed as adherent to the GFD, can be obtained in 66% of patients. Patients with severe histological damage at diagnosis are at risk for incomplete histological recovery 1 year later.

Factors governing long‐term adherence to a gluten‐free diet in adult patients with coeliac disease

“…Our findings of a higher proportion of serological normalisation in patients with adequate adherence as compared to those with inadequate adherence are consistent with previous findings that support that adherence to the diet is key for serological normalisation or clinical improvement. However, serology cannot be reliably used as a marker of adherence to a GFD in patients with CeD.…”

Adherence to the gluten‐free diet can achieve the therapeutic goals in almost all patients with coeliac disease: A 5‐year longitudinal study from diagnosis

“…The time course of the body's recovery has been poorly documented. The few prospective studies undertaken have been limited to 12 months follow-up, 20 and the only study to 5 years did not evaluate coeliac antibodies or thorough body compositional analysis. 17 The current study prospectively examined a relatively large group of newly diagnosed patients with CD to address these key issues.…”

Predictors and Significance of Incomplete Mucosal Recovery in Celiac Disease After 1 Year on a Gluten-Free Diet

“…Th is slower recovery combined with severe atrophy at diagnosis explains why these patients had not regained normal mucosa during 1 year despite a strict diet. Some studies have indirectly investigated whether the speed of histological recovery is associated with the severity of the baseline damage, but results have been controversial ( 5,6,9,15,37,38 ). Th is might be explained by diff erences in dietary adherence and by the use of inexact grouped classifi cations (e.g., Marsh) in histology ( 16 ).…”