Patients with celiac disease (CeD) with persistent villous atrophy (pVA) have an increased risk for complications and mortality, compared with those without pVA, according to study findings published in Gut.
A gluten-free diet (GFD) is the main treatment for patients with CeD. However, some patients still experience villous atrophy (VA) despite maintaining a GFD. Researchers conducted a multicenter, retrospective cohort study to assess the association between pVA and long-term patient outcomes.
The study population included patients aged 18 years and older diagnosed with CeD. Participants were divided into 2 study cohorts. In study cohort 1, the aim was to assess the association between pVA and poor patient long-term outcomes, to assess predictors of pVA, and to develop a pVA predictive score. The aim of cohort 2 was to externally validate the predictive score.
Data for cohort 1 was collected from 3 referral centers from 2000 through 2020.
Study participants in cohort 2 were enrolled prospectively from March 2020 through October 2022 at 3 study centers. Unlike cohort 1, cohort 2 included patients diagnosed or referred at other centers other than those included in the study.
Of the 2,211 patients assessed, 694 (31%) were included in the study cohort. These patients underwent a duodenal biopsy after a median time on a GFD of 32 months (IQR, 15-61). There were 491 women included with a mean [SD] age of 44[16] years at baseline. Of these patients, 83.6%, patients were adherent to a GFD.
There were 157 (23%) patients with pVA. Factors associated with pVA were age 45 and older (odds ratio [OR], 2.01; 95% CI, 1.21-3.34; P <.01), classical CeD (OR, 2.14; 95% CI, 1.28-3.58; P <.01), GFD nonresponse (OR, 2.40; 95% CI, 1.43-4.01; P <.001), and poor GFD adherence (OR, 48.9; 95% CI, 26.1-91.8; P <.001).
There were 44 (6.3%) patients who experienced a complication and 32 patients who died (4.6%) during the study period. Analysis revealed that pVA was associated with complications (HR, 9.53; 95% CI, 4.77-19.04; P <.001) and mortality (HR, 2.93; 95% CI, 1.43-6.02; P <.01).
The researchers developed an externally validated 5-point scoring system (receiver operating characteristic area under the curve [ROC-AUC], 0.78; 95% CI, 0.68-0.89). Patients were stratified by low (0-1 points; 5% pVA), intermediate (2 points; 16% pVA) and high risk (3-5 points; 73% pVA).
“Identification of potential clinical targets in the follow-up of patients with CD is a crucial requirement for clinicians,” study authors wrote. “Based on our results, this includes implementing strategies for obtaining and maintaining over time strict adherence to a GFD, control of persistent symptoms despite a GFD and obtaining deep mucosal healing.”
Study limitations include a lack of diagnosis uniformity, follow-up duodenal biopsies not performed for all patients, and inclusion of patients with seronegative CeD.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
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