In adults with coeliac disease, intestinal damage doesn’t always heal

Coeliac disease is a serious inflammatory condition of the gut which doesn’t always heal, according to research carried out by Dr Joseph A Murray from Mayo Clinic College of Medicine, Rochester, Minnesota USA. Clinical response is observed in most adults with coeliac disease after treatment with a gluten-free diet, however the rate of mucosal recovery of the gut is less certain. This study aimed to assess the rates of mucosal recovery in adults on a gluten-free diet and the implications of persistent mucosal damage.

Dr Murray and colleagues analysed mucosal recovery and all-cause mortality in 241 adults with biopsy-proven celiac disease who had diagnostic and follow-up biopsies. All patients showed some intestinal villous atrophy and nearly half had total villous atrophy. In 165 patients who had follow-up biopsies within two years of diagnosis, only 35% had mucosal recovery. Of the whole 241 patients, after two years 34% had mucosal recovery, and after five years 66% had mucosal recovery. Eighty-two percent had some clinical response to the gluten-free diet, but this was not a clinical marker of mucosal recovery. Those who had poor results with a gluten-free diet, severe celiac disease symptoms such as diarrhoea and weight loss also had persistent mucosal damage.

Dr Murray recommended intestinal biopsy one year after diagnosis, with close surveillance and a follow-up review of diet.

Source: The American Journal of Gastroenterology

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