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

Pekki, Henna; Kurppa, Kalle; Mäki, Markku; Huhtala, Heini; Sievänen, Harri; Laurila, Kaija; Collin, Pekka; Kaukinen, Katri

doi:10.1038/ajg.2015.155

Cited by 66 publications

(95 citation statements)

References 44 publications

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“…Gastrointestinal and psychological symptom scores were no different between cases and controls. Among a cohort of 263 patients who underwent follow‐up biopsy after 1 year on a gluten‐free diet, patients who reported malabsorptive symptoms at the time of initial diagnosis were more likely to have persistent mucosal injury, however gastrointestinal symptoms at the time of follow‐up did not predict histology . Another study compared 42 symptomatic and 27 asymptomatic coeliac disease patients, all on the gluten‐free diet, who underwent follow‐up upper endoscopy .…”

Section: Discussionmentioning

confidence: 99%

Factors associated with villus atrophy in symptomatic coeliac disease patients on a gluten‐free diet

Mahadev

Murray

et al. 2017

Aliment Pharmacol Ther

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Of 1345 symptomatic patients, 511 (38%, 95% CI, 35-41%) were found to have active coeliac disease with persistent villus atrophy, defined as average villus height to crypt depth ratio ≤2.0. On multivariable analysis, older age (OR, 5.1 for ≥70 vs. 18-29 years, 95% CI, 2.5-10.4) was a risk factor while longer duration on gluten-free diet was protective (OR, 0.37, 95% CI, 0.24-0.55 for 4-5.9 vs. 1-1.9 years). Villus atrophy was associated with use of proton-pump inhibitors (PPIs; OR, 1.6, 95% CI, 1.1-2.3), non-steroidal anti-inflammatory drugs (NSAIDs; OR, 1.64, 95% CI, 1.2-2.2), and selective serotonin reuptake inhibitors (SSRIs; OR, 1.74, 95% CI, 1.2-2.5). Symptoms were not associated with villus atrophy after adjusting for covariates. Conclusions A majority of symptomatic coeliac disease patients did not have active disease on follow-up histology. Symptoms were poorly predictive of persistent mucosal injury. The impact of NSAIDs, PPIs, and SSRIs on mucosal healing in coeliac disease warrants further study.

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Section: Discussionmentioning

confidence: 99%

Factors associated with villus atrophy in symptomatic coeliac disease patients on a gluten‐free diet

Mahadev

Murray

et al. 2017

Aliment Pharmacol Ther

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“…However, it is difficult to predict the most appropriate time to perform repeat duodenal biopsies in CD, because the rate of mucosal recovery following the institution of a GFD varies between individuals. Some studies suggest that histological remission occurs in most individuals (68%) within the first year following diagnosis [32]. However, other observational studies have reported histological remission in 34-65% of individuals up to two years post-diagnosis, and others have suggested that mucosal recovery may even take as long as 5 years in some individuals [33][34][35][36].…”

Section: Dietary Indiscretionmentioning

confidence: 99%

Non-Responsive Coeliac Disease: A Comprehensive Review from the NHS England National Centre for Refractory Coeliac Disease

et al. 2020

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Coeliac disease is a common small intestinal enteropathy which manifests following ingestion of gluten in genetically susceptible individuals. Since gluten was identified as the driving factor in coeliac disease, the gluten-free diet (GFD) has remained the mainstay of treatment. While most individuals will display improvement in symptoms and signs of coeliac disease following institution of the GFD, up to 30% will continue to experience symptoms and/or have persisting intestinal inflammation. These individuals can be classified as having non-responsive coeliac disease (NRCD), which may be associated with dietary indiscretion, slow healing, refractory coeliac disease, and/or an alternative condition. The purpose of this review is to provide an overview of the causes of NRCD in adults, highlight a systematic approach to investigate these patients, and appraise the latest management aspects of this subset of coeliac disease.

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“…In accord with our previous study [51], for currently unclear reasons, ASCA levels were generally higher in the IgG class than the IgA class. By contrast, IgA class ASCA seems to be more consistently elevated in IBD [48,52]. Which of these two antibody classes is the more useful marker in CD would be an interesting subject for further research.…”

Section: Discussionmentioning

confidence: 96%

First-degree Relatives of Celiac Disease Patients Have Increased Seroreactivity to Serum Microbial Markers

et al. 2020

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Risk of celiac disease (CD) is increased in relatives of CD patients due to genetic and possible environmental factors. We recently reported increased seropositivity to anti-Saccharomyces cerevisiae (ASCA), Pseudomonas fluorescens-associated sequence (anti-I2) and Bacteroides caccae TonB-linked outer membrane protein (anti-OmpW) antibodies in CD. We hypothesized these markers also to be overrepresented in relatives. Seropositivity and levels of ASCA, anti-I2 and anti-OmpW were compared between 463 first-degree relatives, 58 untreated and 55 treated CD patients, and 80 controls. CD-associated human leukocyte antigen (HLA)-haplotypes and transglutaminase (tTGab) and endomysium (EmA) antibodies were determined. One or more of the microbial antibodies was present in 75% of relatives, 97% of untreated and 87% of treated CD patients and 44% of the controls. The relatives had higher median ASCA IgA (9.13 vs. 4.50 U/mL, p < 0.001), ASCA IgG (8.91 vs. 5.75 U/mL, p < 0.001) and anti-I2 (absorbance 0.74 vs. 0.32, p < 0.001) levels than controls. There was a weak, positive correlation between tTGab and ASCA (r = 0.31, p < 0.001). Seropositivity was not significantly associated with HLA. To conclude, seropositivity to microbial markers was more common and ASCA and anti-I2 levels higher in relatives of CD patients than controls. These findings were not associated with HLA, suggesting the role of other genetic and environmental factors.

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

Cited by 66 publications

References 44 publications

Factors associated with villus atrophy in symptomatic coeliac disease patients on a gluten‐free diet

Factors associated with villus atrophy in symptomatic coeliac disease patients on a gluten‐free diet

Non-Responsive Coeliac Disease: A Comprehensive Review from the NHS England National Centre for Refractory Coeliac Disease

First-degree Relatives of Celiac Disease Patients Have Increased Seroreactivity to Serum Microbial Markers

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