Younger age at diagnosis predisposes to mucosal recovery in celiac disease on a gluten-free diet: A meta-analysis
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BACKGROUND AND AIMS: Persistent intestinal damage is associated with higher complication rates in celiac disease. We aimed to assess the potential modifiers of mucosal recovery. MATERIALS AND METHODS: We screened databases (PubMed, Embase, Cochrane Trials, and Web of Science) for papers on celiac disease. Papers discussing (1) celiac patients (2) follow-up biopsy and (3) mucosal recovery after commencement of a gluten-free diet were included. The primary outcome was to produce a comprehensive analysis of complete mucosal recovery (i.e., Marsh 0 on follow-up). We compared children's recovery ratios to those of adults. Patients following a strict gluten-free dietary regimen were included in a subgroup. Summary point estimates, 95% confidence intervals (CIs), and 95% predictive intervals (PIs) were calculated. Heterogeneity was tested with I2-statistic. The PROSPERO registration number is CRD42016053482. RESULTS: The overall complete mucosal recovery ratio, calculated from 37 observational studies, was 0.36 (CI: 0.28-0.44, PI: -0.12-0.84; I2: 98.4%, p<0.01). Children showed higher complete mucosal recovery ratio than adults (p<0.01): 0.65 (CI: 0.44-0.85, PI: -0.10-1.39; I2: 96.5%, p<0.01) as opposed to 0.24 (CI: 0.15-0.33, PI: -0.19-1.08; I2: 96.3%, p<0.01). In the strict dietary adherence subgroup, complete mucosal recovery ratio was 0.47 (CI: 0.24-0.70, PI: -0.47-1.41; I2: 98.8%, p<0.001). On meta-regression, diagnostic villous atrophy (Marsh 3) ratio (-8.97, p<0.01) and male ratio (+6.04, p<0.01) proved to be a significant determinant of complete mucosal recovery, unlike duration of gluten-free diet (+0.01, p = 0.62). The correlation between complete mucosal recovery ratio and age on diagnosis is of borderline significance (-0.03, p = 0.05). CONCLUSIONS: There is considerable heterogeneity across studies concerning complete mucosal recovery ratios achieved by a gluten-free diet in celiac disease. Several celiac patients fail to achieve complete mucosal recovery even if a strict dietary regimen is followed. Younger age on diagnosis, less severe initial histologic damage and male gender predispose for achieving mucosal recovery.
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Children had a higher frequency of complete histological recovery (65%) and regression of abnormal villous/crypt depth ratio (74%) than adults (24% and 58%, respectively).
“A meta-analysis demonstrated that children had higher frequency of complete histological recovery (65%) and regression of abnormal villous/crypt depth ratio (74%) than adults (24% and 58%, respectively) (90).”
From ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease. (2022) · cites this paper as [90]
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Nutritional Imbalances in Adult Celiac Patients Following a Gluten-Free Diet
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Celiac Disease: Fallacies and Facts
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Efficacy of a Gluten-Free Diet in the Gilles de la Tourette Syndrome: A Pilot Study
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Age‐Dependent Trends in the Celiac Disease
Krauthammer, A., Guz‐Mark, A., Zevit, N., Marderfeld, L., Waisbourd‐Zinman, O., Silbermintz, A., Mozer‐Glassberg, Y., Friedler, V. N., Lev, M. R. B., Matar, M., et al. (2021) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000003130 · Cited by 12 · see citing works
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Elwenspoek, M. M. C., O’Donnell, R., Jackson, J., Everitt, H., Gillett, P. M., Hay, A. D., Jones, H. E., Robins, G. G., Watson, J., Mallett, S., et al. (2022) · EClinicalMedicine · doi:10.1016/j.eclinm.2022.101376 · Cited by 10 · see citing works
Cheng, F. W., & Handu, D. (2020) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2019.09.019 · Cited by 9 · see citing works
Szakács, Z., Csiszár, B., Kenyeres, P., Sarlós, P., Erőss, B. M., Hussain, A., Nagy, Á., Kőszegi, B., Veczák, I., Farkas, N., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-026315 · Cited by 8 · see citing works
Self-citationOutcomes in Adults with Celiac Disease Following a Gluten-Free Diet
Balaban, D. V., Enache, I., Balaban, M., David, R. A., Vasile, A.-D., Popp, A., & Jinga, M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14145144 · Cited by 7 · see citing works
Celiac Disease as a Model of Intestinal Malnutrition: Mechanisms and Nutritional Management
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Venous thromboembolism in chronic gastrointestinal disorders
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Rapid Anti-tTG-IgA Screening Test for Early Diagnosis of Celiac Disease in Pediatric Populations
Mendía, I., Segura, V., Ruiz‐Carnicer, Á., Coto, L., Negrete, M., Long, J. C. D., Reyes-Andrade, J., Amil, B., de la Cueva, I. S., Comino, I., et al. (2023) · Nutrients · doi:10.3390/nu15234926 · Cited by 5 · see citing works
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Monitoring coeliac disease in 2024, time to change practice?
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Decoding gut microbiome alterations in celiac disease: Implications for pathogenesis and treatment
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A case of non-classical celiac disease
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The Role of Endoscopy in Assessing Small Intestine Mucosal Recovery in Patient with Celiac Disease
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- Authors
- Szakács, Z., Mátrai, P., Hegyi, P., Szabó, I., Vincze, Á., Balaskó, M., Mosdósi, B., Sarlós, P., Simon, M., Márta, K., Mikó, A., Pécsi, D., Demcsák, A., & Bajor, J.
- Affiliations
- University of Pecs (HU)
- University of Szeged (HU)
- Corresponding author
- Szakács, Zsolt
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2017-11-02
- Volume
- 12
- Issue
- 11
- Pages
- e0187526
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5695627
- OpenAlex
- W2766941563
- Cited by
- 35
- References
- 119
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 8 · 2021: 4 · 2020: 4 · 2019: 4 · 2018: 1 · 2017: 2
- FWCI
- 0.51
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- SZTE Publicatio Repozitórium (University of Szeged) (acceptedVersion, other-oa)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Economic Development and Innovation Operative Programme Grant of the National Research, Development and Innovation Office, STAY ALIVE (GINOP 2.3.2-15-2016-00048)
- Topics
- Health Sciences › Medicine › Gastroenterology › Celiac Disease Research and Management
- Health Sciences › Medicine › Surgery › Eosinophilic Esophagitis
- Life Sciences › Agricultural and Biological Sciences › Plant Science › Wheat and Barley Genetics and Pathology
- Keywords
- celiac disease, mucosal recovery, gluten-free diet, age at diagnosis, children versus adults, villous atrophy, Marsh classification, dietary adherence, intestinal injury, sex differences, predictors of recovery, pediatric celiac disease, adult-onset celiac disease
- MeSH terms
- Adult, Age Factors, Celiac Disease, Child, Child, Preschool, Female, Humans, Male, Middle Aged, Mucous Membrane, Diet, Gluten-Free
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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