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Histologic Follow-up of People With Celiac Disease on a Gluten-Free Diet
Slow and Incomplete Recovery

Peter J. Wahab MD, PhD, Jos W.R. Meijer MD, Chris J.J. Mulder MD, PhD
DOI: http://dx.doi.org/10.1309/EVXT-851X-WHLC-RLX9 459-463 First published online: 1 September 2002


To assess histologic recovery in response to gluten withdrawal in celiac disease, 158 patients seen in our hospital during a 15-year period underwent follow-up small intestine biopsies (SIBs) within 2 years after starting a gluten-free diet; further SIBs were done if villous atrophy was present. A modified Marsh classification was used (IIIA, partial villous atrophy; IIIB, subtotal villous atrophy; IIIC, total villous atrophy).

Of patients with Marsh IIIA, IIIB, or IIIC lesions, histologic remission was seen in 65.0% within 2 years, 85.3% within 5 years, and 89.9% in long-term follow-up. Eleven patients (7.0%) with persisting (partial) villous atrophy had symptoms and signs of malabsorption and were considered to have refractory celiac disease; 5 of them developed an enteropathy-associated T-cell lymphoma. Children recovered up to 95% within 2 years and 100% in the long-term.

Histologic recovery in celiac disease after starting a gluten-free diet takes time and is incomplete or absent in a substantial subgroup of patients (10.1% villous atrophy after 5 years). Systematic follow-up of patients with celiac disease and the malabsorption syndrome and secondary complications is needed.

Key Words:
  • Celiac disease
  • Small intestinal biopsy
  • Follow-up
  • Refractory
  • Recovery