Long-term mucosal recovery and healing in celiac disease is the rule – not the exception

Abstract

Objective: The prevalence of persistent villous atrophy (VA) in patients with celiac disease (CD) on a gluten-free diet (GFD) varies greatly between studies. Most studies show a relatively high prevalence of mucosal atrophy and inflammation in treated patients, a finding which have led to a concept of non-responsive CD. Few studies have examined the prevalence of long-term mucosal healing. Our study aimed to determine the extent of mucosal healing in a cohort of Norwegian patients with CD treated with GFD for several years.

Materials and methods: Adult patients diagnosed with VA between 1989 and 2009 were included. We performed a follow-up gastroscopy with duodenal biopsies. Two pathologists evaluated the biopsies according to the Marsh–Oberhuber classification. Mucosal healing was defined as Marsh 0 while mucosal recovery was defined as Marsh 0-2.

Results: Duodenal biopsies were obtained from 127 adult patients with established CD. After a follow-up time of 8.1 years (median, range 2.3–22.3), 103 (81%) of the patients showed mucosal healing, 120 patients (94%) showed mucosal recovery, and 7 patients (6%) showed persistent VA. In addition, 103 of the 127 patients (81%) had undergone a routine follow-up biopsy 12.6 months (median, range 5.2–28.8) after diagnosis. At the time of the routine follow-up, only 52 of these patients (50.5%) had achieved mucosal recovery.

Conclusions: Although half of the patients had persistent VA at the time of routine follow-up, both long-term mucosal recovery and healing is possible for the vast majority of adult patients with CD.

Keywords:

• Celiac disease
• endoscopy general
• gastroduodenal clinic
• malabsorption mucosal function
• nutrition
• small intestinal disorders

Acknowledgements

We wish thank the nurses Margot Kvikshaug and Jane Rue at Sørlandet Hospital HF, Arendal for their valuable assistance with both endoscopic examination and data registration. We also want to thank Jorunn Bratlie at Oslo University Hospital, for biobank administration and logistics.

Disclosure statement

The authors have no financial or personal conflicts of interest to declare.