Persistent small bowel mucosal villous atrophy without symptoms in coeliac disease.

Abstract:

BACKGROUND:Refractory sprue with malabsorption carries a risk of lymphoma. AIM:To examine whether a good clinical but poor histological response during a strict gluten-free diet predicts a poor outcome. METHODS:The study involved all coeliac patients who showed no histological recovery within 2 years on a strict gluten-free diet. Small intestinal biopsy and bone mineral density were investigated in 2001 and clinical features were followed up until 2005. The results were compared to those in 18 coeliac patients with a good histological recovery. RESULTS:Thirteen coeliac patients had persistent small intestinal villous atrophy despite maintaining gluten-free diet. All had demonstrated a good clinical response. Osteoporosis was found in 58% and 22% of the non-responders and responders, respectively (P = 0.04). In 2005, two of the non-responders had developed symptomatic refractory sprue, one died of lymphoma and one of carcinoid tumour, and one gastric adenocarcinoma was operated. None of the 18 controls had developed refractory sprue or malignancy. The frequency of histological non-responsive disease was 1.9%. CONCLUSIONS:Persistent villous atrophy in adult coeliac disease, even in the absence of symptoms, carries a risk of subsequent severe complications. The follow-up biopsy is important in detecting these individuals.

journal_name

Aliment Pharmacol Ther

authors

Kaukinen K,Peräaho M,Lindfors K,Partanen J,Woolley N,Pikkarainen P,Karvonen AL,Laasanen T,Sievänen H,Mäki M,Collin P

doi

10.1111/j.1365-2036.2007.03311.x

subject

Has Abstract

pub_date

2007-05-15 00:00:00

pages

1237-45

issue

10

eissn

0269-2813

issn

1365-2036

pii

APT3311

journal_volume

25

pub_type

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