Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Dec 5, 2018; 9(6): 55-62
Published online Dec 5, 2018. doi: 10.4292/wjgpt.v9.i6.55
Coeliac disease in the modern era: Severity of small bowel mucosal injury at diagnosis with analysis of clinical correlates and rate of improvement on a gluten free diet
Oliver Cronin, Emma Flanagan, Damian Dowling
Oliver Cronin, Damian Dowling, Department of Gastroenterology, University Hospital Geelong, Geelong 3220, Australia
Emma Flanagan, Department of Gastroenterology, St Vincent’s Hospital, Fitzroy 3065, Australia
Author contributions: Dowling D designed the research and critically revised the manuscript; Flanagan E collected the data; Cronin O analyzed the data and wrote the manuscript.
Institutional review board statement: This study was reviewed and approved by the Barwon Health Human Research Ethics Committee (Geelong, Australia).
Conflict-of-interest statement: There are no conflicts of interest to report.
STROBE statement: Guidelines from the STROBE statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Oliver Cronin, MBBS, Doctor, Department of Gastroenterology, University Hospital Geelong, Ryrie St & Bellerine St, Geelong 3220, Australia. oliver.cronin@barwonhealth.org.au
Telephone: +61-3-42150000 Fax: +61-3-42150000
Received: May 25, 2018
Peer-review started: May 25, 2018
First decision: June 13, 2018
Revised: July 9, 2018
Accepted: July 21, 2018
Article in press: July 21, 2018
Published online: December 5, 2018
Processing time: 194 Days and 16.6 Hours
Abstract
AIM

To analyze the relationships between pre-diagnosis coeliac serology, duodenal histopathology, primary presenting symptoms, coeliac-related comorbidity and response to treatment in a modern cohort with new diagnosis of coeliac disease (CD).

METHODS

A retrospective cohort study including 99 participants diagnosed with CD between 1999 and 2013. All patients had the following data recorded: baseline characteristics, coeliac serology, small bowel histopathology. A subset of this cohort underwent a repeat small bowel biopsy. Independent associations were assessed with logistic regression.

RESULTS

The mean age at diagnosis was 43 years (Interquartile range 30-53 years) and 68% of the cohort was female. At diagnosis 49 (49%) patients had total villous blunting (MS 3c), 12 (12%) had subtotal villous blunting (MS 3b), and 29 (29%) had partial villous blunting (MS 3a). The prevalence of symptoms pre diagnosis was not related to the severity of villous blunting (P = 0.490). 87 (88%) of the cohort underwent repeat small bowel biopsy after a median of 7 mo (IQR 6-11 mo). 34 (39%) patients had biopsy results ≥ MS 3a which compared to 90 (90%) at the initial biopsy. 24 (71%) of this group reported adherence to a gluten free diet (GFD). Persistent MS ≥ 3a at repeat biopsy was not associated with symptoms (P = 0.358) or persistent positive coeliac serology (P = 0.485).

CONCLUSION

Neither symptoms nor serology predict the severity of the small bowel mucosal lesion at CD diagnosis. Whilst a GFD was associated with histological improvement many patients with newly diagnosed CD had persistent mucosal damage despite many months of gluten restriction. Negative CD serology did not exclude ongoing mucosal injury.

Keywords: Coeliac disease; Gluten-free diet

Core tip: Coeliac disease (CD) is a common, under-recognized gastrointestinal disorder. The findings in this study support other larger studies which have reported a trend toward an asymptomatic or silent presentation of CD. Thyroid related autoimmune co-morbidities were common (n = 17, 17%). Symptoms at presentation were not associated with the degree of villous blunting on biopsy. Similarly, persistent villous blunting at repeat biopsy was not associated with symptoms or positive coeliac serology. Negative coeliac serology did not exclude ongoing mucosal injury.