Persistent Villous Atrophy in De Novo Adult Patients With Celiac Disease and Strict Control of Gluten-Free Diet Adherence: A Multicenter Prospective Study (CADER Study).
Study Goal
The researchers aimed to evaluate the persistence of villous atrophy after 2 years on a strict gluten-free diet in adult celiac disease patients, assessing the role of inadvertent gluten exposure.
Results Summary
Persistent villous atrophy was observed in 53% of patients despite strict dietary control, with 69% showing detectable gluten immunogenic peptides in fecal samples. Older age was significantly associated with persistent villous atrophy, but no differences in gluten exposure levels were found between those with atrophy and those who recovered.
Population
Symptomatic adult patients with newly diagnosed celiac disease (mean age 36.5 ± 1.6 years, 73% women).
Effective Dosage
Not specified
Duration
2 years
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
gluten-free diet | no change | villous atrophy | adult patients with celiac disease | substantial proportion | exhibit persistent villous atrophy | #1 |
gluten-free diet with strict control of gluten exposure | no change | villous atrophy | de novo adult patients with celiac disease | 53% | persistent villous atrophy was observed | #2 |
gluten-free diet with strict control of gluten exposure | decrease | symptoms | patients with persistent villous atrophy | 72.5% | were asymptomatic | #3 |
gluten-free diet with strict control of gluten exposure | decrease | serology | patients with persistent villous atrophy | 75% | had negative serology | #4 |
gluten-free diet with strict control of gluten exposure | increase | fecal gluten immunogenic peptides (f-GIPs) | patients | 69% | Detectable f-GIP >0.08 μg/g in at least 1 fecal sample was seen | #5 |
gluten-free diet with strict control of gluten exposure | no change | fecal gluten immunogenic peptides (f-GIPs) | patients with persistent villous atrophy vs those who recovered | no significant differences | no significant differences in the median f-GIP at each visit and median area under the curve | #6 |
gluten-free diet with strict control of gluten exposure | increase | persistent villous atrophy | de novo adult patients with celiac disease | 32% for 16-30 years; 67% for >30 years | older age was associated with persistent villous atrophy | #7 |
INTRODUCTION: A substantial proportion of adult patients with celiac disease on a gluten-free diet exhibit persistent villous atrophy, and inadvertent gluten exposure may be one of the causes. The aim of the present study was to evaluate villous atrophy persistence after 2 years on a gluten-free diet in de novo adult patients with celiac disease with strict control of gluten exposure. METHODS: Symptomatic de novo adult patients with celiac disease were prospectively included. Clinical visits and dietary surveillance were scheduled every 6 months during a 2-year follow-up period. At each visit, fecal samples were collected and stored at -20 °C until analysis for gluten immunogenic peptides (f-GIPs). A follow-up duodenal biopsy was performed at 2 years. We evaluated the variables associated with persistent villous atrophy. RESULTS: Seventy-six patients completed the study (36.5 ± 1.6 years, 73% women); persistent villous atrophy was observed in 40 (53%), whereas 72.5% were asymptomatic and 75% had negative serology. Detectable f-GIP >0.08 μg/g in at least 1 fecal sample was seen in 69% of patients. There were no significant differences in the median f-GIP at each visit and median area under the curve over the serial measurements between patients with persistent villous atrophy and those who recovered. On multivariate analysis, only older age was associated with persistent villous atrophy (32% for 16-30 years; 67% for >30 years; P = 0.016). DISCUSSION: The rate of persistent villous atrophy after 2 years was high in adult patients with celiac disease on an intentionally strict gluten-free diet. Low-level ongoing inadvertent gluten exposure could be a contributing factor to persistent villous atrophy.