Over half of individuals diagnosed with celiac disease who adhere to a gluten-free (GF) diet will remain symptomatic, regardless of mucosal healing, after 5 years, according to study findings published in the Journal of Clinical Gastroenterology.
Researchers conducted a retrospective chart review on 212 eligible individuals (women, 69%; mean age at diagnosis, 43 years) with biopsy-confirmed celiac disease adhering to a GF diet. The purpose of the study was to assess symptom outcomes in those with celiac disease after adherence to a GF diet during the 5 years after initial diagnosis.
Of these 212 individuals, 158 (74.5%) demonstrated mucosal healing as evidenced by the absence of villous atrophy and crypt hyperplasia after small bowel biopsy during the first 5 years. In contrast, 47 individuals did not have healing after 5 years from initial diagnosis; however, 15 of the 47 individuals only had follow-up biopsies done within the first 2 years after diagnosis, which was too early to determine whether mucosal healing occurred.
During the 5-year follow-up period, more than 50% of individuals were symptomatic or demonstrated persistent signs of celiac disease. Many patients experienced the same symptoms that prompted initial diagnosis, such as diarrhea, abdominal pain, bloating, weight loss, and constipation. Older age at diagnosis (P =.003) and male biological sex (P =.000003) were both associated with lower risk of being symptomatic during follow-up.
Mucosal healing that was associated with adherence to a GF diet did not significantly alter the proportion of individuals who remained symptomatic after 5 years from diagnosis (healed symptomatic vs unhealed symptomatic: 61.2% vs 64.3%; P =1.00). Similarly, the clinical manifestation of persistent symptoms after 5 years was not significantly different in the 158 individuals who achieved mucosal healing compared with the 47 individuals who did not (56.7% vs 44.4%; P =.71).
“Our findings therefore stress the importance of close follow-up after diagnosis, screening for persistent symptoms, having a low threshold for investigation into alternative explanations, and considering follow-up biopsy even in the presence of clinical remission,” study authors noted.
Study limitations include the retrospective design, incomplete data sets, risk for referral bias, and the inability to assess factors such as the impact of length of symptoms on likelihood of persistent symptoms. The researchers also used physician interpretation via documentation, instead of objective tests, to explain reasons underlying persistent symptoms. They also used patient self-reporting to determine adherence to GF diet, which potentially missed inadvertent gluten exposures.
Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.
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