eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
Current issue Archive Manuscripts accepted About the journal Special issues Editorial board Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
vol. 14
Clinical research

Histologic recovery among children with celiac disease on a gluten-free diet. A long-term follow-up single-center experience

Oana Belei, Andreea Dobrescu, Rodica Heredea, Emil Radu Iacob, Vlad David, Otilia Marginean

Arch Med Sci 2018; 14, 1: 94–100
Online publish date: 2017/12/19
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
Introduction: Celiac disease (CD) is defined by gluten-induced immune-mediated enteropathy, affecting approximately 1% of the genetically predisposed population. The immunologic response to gluten causes characteristic intestinal alterations with gradual development. Histologic recovery of intestinal architecture was reported to occur within 6–12 months after starting a gluten-free diet, simultaneously with clinical remission. The aim of this study was to assess the rate and timing of histologic recovery among children with CD on a gluten-free diet, diagnosed and followed in an academic referral pediatric center during a 10-year period.

Material and methods: 105 biopsy-confirmed CD children underwent follow-up small intestinal biopsies within at least 1 year after dietary gluten withdrawal. Further biopsies were performed if villous alterations were persistent. The Marsh classification modified by Oberhuber was used to score the histologic injuries.

Results: In all 19 cases with Marsh type II at diagnosis, villous alterations normalized to Marsh type 0 within the first year. From 86 children enrolled with Marsh type III lesions, histologic remission was observed in 81.4% after 1 year, 91.8% within 2–3 years and 97.6% in long-term follow up (≥ 3 years). Two (2.3%) patients with concomitant selective IgA deficiency had symptoms of malabsorption and persisting villous atrophy lasting more than 3 years despite a gluten-free diet. There was a significant statistic difference between the proportion of children with Marsh type IIIA, type IIIB and Marsh type IIIC respectively that achieved histologic recovery within 1 to 2 years after gluten withdrawal. There were more children with partial 25 (92.6%) and subtotal villous atrophy 30 (88.2%) showing histologic improvement, compared to only 15 (60%) patients with total villous atrophy that recovered within the first 2 years of diet (p = 0.01 and p = 0.02 respectively).

Conclusions: Histologic recovery in CD after starting a gluten-free diet in children takes at least 1 year and might be incomplete only in a small proportion of children, mainly associated with IgA immunodeficiency. Systematic follow-up of children with CD and persistent malabsorption syndrome is needed in order to avoid secondary complications.

endoscopy, intestinal biopsy, villous atrophy

Chou R, Bougatsos C, Blazina I, Mackey K, Grusing S, Selph S. Screening for celiac dsease: evidence report and systematic review for the US Preventive Services Task Force. JAMA 2017; 317: 1258-68.
Kelly CP, Bai JC, Liu E, Leffler DA. Advances in diagnosis and management of celiac disease. Gastroenterology 2015; 148: 1175-86.
Husby S, Koletzko S, Korponay-Szabó IR, et al. European Society for Pediatric Gastroenterology, Hepatology and Nutrition Guidelines for the Diagnosis of Coeliac Disease. J Pediatr Gastroent Nutr 2012; 54: 136-60.
Marsh MN. Gluten, major histocompatibility complex and the small intestine: a molecular and immunobiologic approach to the spectrum of gluten sensitivity (“celiac sprue”). Gastroenterology 1992; 102: 330-54.
Wahab PJ, Crusius JBA, Meijer JWR, Mulder CJ. Gluten challenge in borderline gluten sensitive enteropathy. Am J Gastroenterol 2001; 96: 1464-9.
Kurppa K, Collin P, Viljamaa M, et al. Diagnosing mild enteropathy celiac disease: a randomized, controlled clinical study. Gastroenterology 2009; 136: 816-23.
Taavela J, Koskinen O, Huhtala H, et al. Validation of morphometric analyses of small-intestinal biopsy readouts in celiac disease. PLoS One 2013; 8: e76163.
Wahab P, Meijer J, Mulder C. Histologic follow-up of people with celiac disease on a gluten-free diet. Am J Clin Pathol 2002; 118: 459-63.
Oberhuber G. Histopathology of celiac disease. Biomed Pharmacother 2000; 54: 368-72.
Corazza GR, Villanacci V. Coeliac disease. J Clin Pathol 2005; 58: 573-4.
Rubio-Tapia A, Rahim MW, See JA, Lahr BD, Wu TT, Murray JA. Mucosal recovery and mortality in adults with celiac disease after treatment with a gluten free diet. Am J Gastroenterol 2010; 105: 1412-20.
Pallav K, Xu H, Leffler DA, Kabbani T, Kelly CP. Immunoglobulin A deficiency in celiac disease in the United States. J Gastroenterol Hepatol 2016; 31: 133-7.
Chow MA, Lebwohl B, Reilly NR, Green PH. Immunoglobulin A deficiency in celiac disease. J Clin Gastroenterol 2012; 46: 850-4.
Korponay-Szabo IR, Dahlbom I, Laurila K, et al. Elevation of IgG antibodies against tissue transglutaminase as a diagnostic tool for coeliac disease in selective IgA deficiency. Gut 2003; 52: 1567-71.
Olaussen RW, Lovik A, Tollefsen S, et al. Effect of elemental diet on mucosal immunopathology and clinical symptoms in type 1 refractory celiac disease. Clin Gastroenterol Hepatol 2005; 3: 875-85.
Mandal A, Mayberry J. Elemental diet in the treatment of refractory coeliac disease. Eur J Gastroenterol Hepatol 2001; 13: 79-80.
Biagi F, Corazza GR. Defining gluten refractory enteropathy. Eur J Gastroenterol Hepatol 2001; 13: 561-5.
Mooney PD, Evans KE, Singh S, Sanders DS. Treatment failure in coeliac disease: a practical guide to investigation and treatment of non-responsive and refractory coeliac disease. J Gastrointest Liver Dis 2012; 21: 197-203.
Jańczyk W, De Roo JHC, Schweizer J, Socha J, Socha P, Mearin L. Coeliac disease not responding to a gluten free diet in children: case studies and literature review. Dev Period Med 2015; 29: 162-6.
Cellier C, Patey N, Mauvieux L, et al. Abnormal intestinal intraepithelial lymphocytes in refractory sprue. Gastroenterology 1998; 114: 471-81.
Rubio-Tapia A, Kelly DG, Lahr BD, Dogan A, Wu TT, Murray JA. Clinical staging and survival in refractory celiac disease: a single center experience. Gastroenterology 2009; 136: 99-107.
Ravelli A, Villanacci V. Tricks of the trade: how to avoid histological pitfalls in celiac disease. Pathol Res Pract 2012; 208: 197-202.
Arguelles-Grande C, Tennyson CA, Lewis SK, Green PH, Bhagat G. Variability in small bowel histopathology reporting between different pathology practice settings: impact on the diagnosis of coeliac disease. J Clin Pathol 2012; 65: 242-7.
Rostom A, Murray JA, Kagnoff MF. American Gastroenterological Association (AGA) institute technical review on the diagnosis and management of celiac disease. Gastroenterology 2006; 131: 1981-2002.
Hill ID, Dirks MH, Liptak GS, et al. North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Clinical Guideline. Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2005; 40: 1-19.
Villanacci V, Ceppa P, Tavani E, Vindigni C, Volta U, Gruppo Italiano Patologi Apparato Digerente (GIPAD), Società Italiana di Anatomia Patologica e Citopatologia Diagnostica/International Academy of Pathology, Italian division (SIAPEC/IAP). Coeliac disease: the histology report. Dig Liver Dis 2011; 43 (Suppl 4): S385-95.
Chang F, Mahadeva U, Deere H. Pathological and clinical significance of increased intraepithelial lymphocytes (IELs) in small bowel mucosa. APMIS 2005; 113: 385-99.
Grefte JM, Bouman JG, Grond J, Jansen W, Kleibeuker JH. Slow and incomplete histological and functional recovery in adult gluten sensitive enteropathy. J Clin Pathol 1988; 41: 886-91.
Krok KL, Wagennar RR, Kantsevoy SV, Thuluvath PJ. Esophageal capsule endoscopy is not the optimal technique to determine the need for primary prophylaxis in patients with cirrhosis. Arch Med Sci 2016; 12: 365-71.
Aday U, Duman M, Deđer KC, et al. Endoscopic approach to anastomotic leaks: partially covered self-expandable stents. A single center’s experience. Arch Med Sci Civil Dis 2017; 2: e29-e34.
Quick links
© 2018 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe