Histological recovery of duodenal mucosa in CD
| Study | Country | Number of patients | Female patients (%) | Median (M)/average (A) follow-up, years | Positive correlation between dietary adherence and mucosal improvement | Symptoms assessed | Main reason for mucosal damage | Histological recovery of duodenal mucosa | ||
|---|---|---|---|---|---|---|---|---|---|---|
| Normal | Improved | No change/worse | ||||||||
| Hutchinson et al156 | UK | 284 | 71 | 1.9 (M) | p=0.014 | No | 9% poor adherence | 35% | 40% | 20.10% |
| Rubio Tapia et al150 | USA | 241 | 73 | –* | p<0.01 | Yes | Poor adherence/severe CD at diagnosis | 66% (5 years) | 19% (2–5 years) | |
| Lanzini et al 159 | Italy | 465 | 77† | 1.3 (A) | p=0.029 | Yes | 25% poor adherence | 8% | 65% | 27% |
| Ciacci et al158 | Italy | 390 | 77 | 6.9 (A) | p<0.001 | Yes | Poor adherence | 43.60% | 32.60% | |
| Wahab et al160 | The Netherlands | 158 | 72 | 1–2‡ | No data | NRCD=symptoms | 65% | 17.1% (5 years) | ||
| Kaukinen (specific study of NRCD)151 | Finland | 591 13 with NRCD | 69% of those with NRCD | 0.7 (M)§ | p=0.02†† | Became symptomatic if NRCD | 46% poor adherence | 1.90% | ||
| Tuire et al72 | Finland | 177 | 73 | 7–10¶ | No correlation** | Patients asymptomatic Clinical relevance of persistent IELs with normal villi | 85% | |||
| Lebwohl et al155 | Sweden | 7648 | 63 | 1.3 (M) | No data | no | No data | 57% | 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.