Original article
Alimentary tract
Degree of Damage to the Small Bowel and Serum Antibody Titers Correlate With Clinical Presentation of Patients With Celiac Disease

https://doi.org/10.1016/j.cgh.2012.09.030Get rights and content

Background & Aims

In patients with celiac disease, gluten-induced lesions of the small-bowel mucosa develop gradually. However, it is not clear whether clinical presentation correlates with the degree of mucosal damage based on histology analysis. We investigated whether the degree of mucosal damage to the small bowel correlates with clinical presentation and serum markers of celiac disease.

Methods

We collected results from serology tests and mucosal biopsy samples from 638 consecutive patients with celiac disease and compared them with reported gastrointestinal symptoms, health-related quality-of-life scores, results from laboratory tests, and bone mineral densities of patients. We assessed mucosal injury based on the ratio of villous height to crypt depth, numbers of intraepithelial CD3+ cells, and semiquantitative Marsh classification criteria. Correlations were established based on the Pearson or Spearman coefficients.

Results

The ratio of the villous height to crypt depth correlated with the severity of gastrointestinal symptoms, quality-of-life scores, laboratory test results, numbers of intraepithelial CD3+ cells, and serum levels of antibodies associated with celiac disease. There was no correlation between the ratio of villous height to crypt depth and bone mineral density. The number of intraepithelial CD3+ cells was not associated with symptoms, whereas the Marsh classification and serum levels of antibodies associated with celiac disease correlated with gastrointestinal symptoms, laboratory test results, and numbers of intraepithelial CD3+ cells.

Conclusions

The ratio of small-bowel villous height to crypt depth and results from serology tests correlate with reported symptoms and quality of life of patients with celiac disease. Patient-reported outcomes are therefore of value, in addition to histology findings, in assessing patients with celiac disease.

Section snippets

Materials and Methods

The study was based on 638 consecutive gastrointestinal endoscopies performed on 445 celiac disease patients at the Department of Gastroenterology and Alimentary Tract Surgery (Tampere University Hospital). All celiac disease diagnoses were based on the demonstration of small-bowel mucosal villous atrophy and crypt hyperplasia.2 Both newly diagnosed patients and patients on a gluten-free diet for at least 1 year were included.

Exclusion criteria for the study were inadequacy or poor quality of

Results

The baseline characteristics of the participants are shown in Table 1. The majority of the small-bowel mucosal biopsy specimens were from celiac patients with gastrointestinal symptoms, but up to 44% originated from subjects diagnosed by screening in at-risk groups or because of extraintestinal manifestations of celiac disease. All participants had the celiac disease–associated human leukocyte antigen types DQ2 or DQ8, or both. In untreated patients the mean Z-score was −0.10 in the lumbar

Discussion

The results showed significant correlations between the degree of small-bowel mucosal morphologic damage and most of the measured clinical outcomes in celiac disease. Of particular interest was the correlation observed between morphologic injury and patient-reported gastrointestinal symptoms and health-related quality of life. Interestingly, such correlation was present even in patients on a gluten-free diet, which would imply that in symptomatic subjects the mucosal structure remains

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    Conflicts of interest The authors disclose no conflicts.

    Funding This study and the Celiac Disease Study Group are supported by the Academy of Finland Research Council for Health, the Competitive Research Funding of the Pirkanmaa Hospital District, the Sigrid Juselius Foundation, the Maud Kuistila Foundation, the Foundation for Paediatric Research, the Ehrnrooth Foundation, and the Finnish Gastroenterology Society.

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