Table 3

Histological recovery of duodenal mucosa in CD

StudyCountryNumber of patientsFemale patients (%)Median (M)/average (A) follow-up, yearsPositive correlation between dietary adherence and mucosal improvementSymptoms assessedMain reason for mucosal damageHistological recovery of duodenal mucosa
NormalImprovedNo change/worse
Hutchinson et al156UK284711.9 (M)p=0.014No9% poor adherence35%40%20.10%
Rubio Tapia et al150USA24173–*p<0.01YesPoor adherence/severe CD at diagnosis66% (5 years) 19% (2–5 years)
Lanzini et al 159Italy46577†1.3 (A)p=0.029Yes25% poor adherence8%65%27%
Ciacci et al158Italy390776.9 (A)p<0.001YesPoor adherence43.60%32.60%
Wahab et al160The Netherlands158721–2‡No dataNRCD=symptoms65%17.1% (5 years)
Kaukinen (specific study of NRCD)151Finland591
13 with NRCD
69% of those with NRCD0.7 (M)§p=0.02††Became symptomatic if NRCD46% poor adherence1.90%
Tuire et al72Finland177737–10¶No correlation**Patients asymptomatic Clinical relevance of persistent IELs with normal villi85%
Lebwohl et al155Sweden7648631.3 (M)No datanoNo data57%43%
  • This table is restricted to studies involving at least 100 patients and presents available data on histological recovery of the duodenal mucosa.

  • Comment on table: In adult studies with >100 patients, non-adherence to a gluten-free diet is a major reason for poor outcome. Symptoms are not a reliable predictor of mucosal healing. Antibodies are not good enough to predict small intestinal damage,149 so a follow-up biopsy is important. Lymphocytic duodenosis is common, but not significant in contribution to symptoms, although it correlates with transgression of adherence to diet.

  • *Authors present mucosal recovery rate according to Kaplan–Meier at 2-year and 5-year follow-up.

  • †The authors do not present an exact percentage (or absolute number of female patients). The percentage 77% is based on reported data that the female:male ratio was 3.3:1.

  • ‡No absolute follow-up time is reported but first follow-up biopsies were carried out between 1 and 2 years after coeliac diagnosis.

  • §Median duration in individuals with persistent villous atrophy. The paper contains no data on the follow-up of the 580 with improved mucosa.

  • ¶Median duration was 7 years in those with persistent villous atrophy but 10 years in those with normal mucosa. The abstract of the paper states an average follow-up of 11 years but that figure is not reported in the paper.

  • **All individuals, also those with persistent mucosal villous atrophy, had a good dietary adherence. Hence, there can be no positive correlation between dietary adherence and mucosal improvement.

  • ††p value (Fisher's exact test) calculated by us based on 6/13 versus 0/18 with poor dietary adherence; see table 1 in original publication for explanation.

  • CD, coeliac disease; IEL, intraepithelial lymphocyte; NRCD, non-responsive CD.