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Cited by 26Celiac Disease Research and ManagementEosinophilic EsophagitisWheat and Barley Genetics and Pathology

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

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Belei, Oana, Dobrescu, Andreea, Heredea, Rodica, Iacob, Emil Radu, David, Vlad, Marginean, Otilia·2018·Archives of Medical Science
DOI 10.5114/aoms.2018.72241PMC PMC5778430
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Abstract

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.

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  • In the scarce literature regarding persisting villous atrophy in celiac disease children on a gluten-free diet, the prevalence was 2%-19% at 1-3 years after diagnosis.

    “In the scarce literature regarding persisting villous atrophy in CD children on a GFD, we found a prevalence of 2%-19% at 1-3 years after CD diagnosis (75, 85-89).”

    From ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease. (2022) · cites this paper as [88]

    The Results (Table I; page unavailable) show that 81.4% of children with initial villous atrophy recovered within 1–2 years, leaving 18.6% without histologic remission—approximately the claimed 19%. The approximately 2% figure comes from follow-up at ≥3 years, not clearly within the claimed 1–3-year window. The Discussion describes pediatric studies on this topic as few. (LLM, conf=0.88)

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Research works printed but not linked: 29

  1. [1]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 28350935
  2. [2]Kelly CP Bai JC Liu E Leffler DA Advances in diagnosis and management of celiac disease Gastroenterology 2015 148 1175 86 25662623 PMC4409570
  3. [3]Husby S Koletzko S Korponay-Szabó IR European Society for Pediatric Gastroenterology, Hepatology and Nutrition Guidelines for the Diagnosis of Coeliac Disease J Pediatr Gastroent Nutr 2012 54 136 60 22197856
  4. [4]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 1727768
  5. [5]Wahab PJ Crusius JBA Meijer JWR Mulder CJ Gluten challenge in borderline gluten sensitive enteropathy Am J Gastroenterol 2001 96 1464 9 11374684
  6. [6]Kurppa K Collin P Viljamaa M Diagnosing mild enteropathy celiac disease: a randomized, controlled clinical study Gastroenterology 2009 136 816 23 19111551
  7. [7]Taavela J Koskinen O Huhtala H Validation of morphometric analyses of small-intestinal biopsy readouts in celiac disease PLoS One 2013 8 e76163 24146832 PMC3795762
  8. [8]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 12219789
  9. [9]Oberhuber G Histopathology of celiac disease Biomed Pharmacother 2000 54 368 72 10989975
  10. [10]Corazza GR Villanacci V Coeliac disease J Clin Pathol 2005 58 573 4 15917404 PMC1770677
  11. [11]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 20145607 PMC2881171
  12. [12]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 26412412 PMC4718864
  13. [13]Chow MA Lebwohl B Reilly NR Green PH Immunoglobulin A deficiency in celiac disease J Clin Gastroenterol 2012 46 850 4 22476042
  14. [14]Korponay-Szabo IR Dahlbom I Laurila K Elevation of IgG antibodies against tissue transglutaminase as a diagnostic tool for coeliac disease in selective IgA deficiency Gut 2003 52 1567 71 14570724 PMC1773847
  15. [15]Olaussen RW Lovik A Tollefsen S Effect of elemental diet on mucosal immunopathology and clinical symptoms in type 1 refractory celiac disease Clin Gastroenterol Hepatol 2005 3 875 85 16234025
  16. [16]Mandal A Mayberry J Elemental diet in the treatment of refractory coeliac disease Eur J Gastroenterol Hepatol 2001 13 79 80 11204817
  17. [17]Biagi F Corazza GR Defining gluten refractory enteropathy Eur J Gastroenterol Hepatol 2001 13 561 5 11396537
  18. [18]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 22720310
  19. [19]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 26384116
  20. [20]Cellier C Patey N Mauvieux L Abnormal intestinal intraepithelial lymphocytes in refractory sprue Gastroenterology 1998 114 471 81 9496937
  21. [21]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 18996383 PMC3466593
  22. [22]Ravelli A Villanacci V Tricks of the trade: how to avoid histological pitfalls in celiac disease Pathol Res Pract 2012 208 197 202 22417775
  23. [23]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 22081783
  24. [24]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 17087937
  25. [25]Hill ID Dirks MH Liptak GS 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 15625418
  26. [26]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 21459344
  27. [27]Chang F Mahadeva U Deere H Pathological and clinical significance of increased intraepithelial lymphocytes (IELs) in small bowel mucosa APMIS 2005 113 385 99 15996156
  28. [28]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 3170777 PMC1141622
  29. [29]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 27186182 PMC4848367

Cited by

Sorted by citations

Authors
Belei, O., Dobrescu, A., Heredea, R., Iacob, E. R., David, V., & Marginean, O.
Affiliations
Victor Babeș University of Medicine and Pharmacy Timișoara (RO)
Corresponding author
Iacob, Emil Radu
ORCID
Venue
Archives of Medical Science
Publisher
Termedia Sp. z.o.o.
Published
2018
Volume
1
Issue
1
Pages
94-100
ISSN
1734-1922 (ISSN-L)
DOI
10.5114/aoms.2018.72241
PMC
PMC5778430
OpenAlex
W2781386580
Cited by
26
References
0
Citations by year
2026: 2 · 2025: 3 · 2024: 1 · 2023: 4 · 2022: 2 · 2021: 5 · 2020: 7 · 2019: 2
FWCI
3.33
Type
journal article
Language
en
Open access
Licence
cc-by-nc-sa
Locations
  • Archives of Medical Science (publishedVersion, cc-by-nc-sa)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-sa)
  • PubMed Central (publishedVersion, cc-by-nc-sa)
  • PubMed (publishedVersion)
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, gluten-free diet, villous atrophy, Marsh classification, children, selective IgA deficiency, malabsorption, small bowel biopsy, long-term follow-up

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