S Mahadev1, J A Murray2, T-T Wu3, V S Chandan3, M S Torbenson3, C P Kelly4, M Maki5, P H R Green1, D Adelman6, B Lebwohl1. 1. Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, USA. 2. Division of Gastroenterology and Hepatology, The Mayo Clinic, Rochester, MN, USA. 3. Department of Laboratory Medicine and Pathology, The Mayo Clinic, Rochester, MN, USA. 4. Celiac Center, Beth Israel Deaconess Medical Center and Celiac Research Program, Harvard Medical School, Boston, MA, USA. 5. Tampere Center for Child Health Research, School of Medicine, University of Tampere and Tampere University Hospital, Finland, Europe. 6. Division of Allergy/Immunology, Department of Medicine, University of California, San Francisco, CA, USA.
Abstract
BACKGROUND: Duodenal injury persists in some coeliac disease patients despite gluten-free diet, and is associated with adverse outcomes. AIM: To determine the prevalence and clinical risk factors for persistent villus atrophy among symptomatic coeliac disease patients. METHODS: A nested cross-sectional analysis was performed on coeliac disease patients with self-reported moderate or severe symptoms while following a gluten-free diet, who underwent protocol-mandated duodenal biopsy upon enrolment in the CeliAction clinical trial. Demographic factors, symptom type, medication use, and serology were examined to determine predictors of persistent villus atrophy. RESULTS: Of 1345 symptomatic patients, 511 (38%, 95% CI, 35-41%) were found to have active coeliac disease with persistent villus atrophy, defined as average villus height to crypt depth ratio ≤2.0. On multivariable analysis, older age (OR, 5.1 for ≥70 vs. 18-29 years, 95% CI, 2.5-10.4) was a risk factor while longer duration on gluten-free diet was protective (OR, 0.37, 95% CI, 0.24-0.55 for 4-5.9 vs. 1-1.9 years). Villus atrophy was associated with use of proton-pump inhibitors (PPIs; OR, 1.6, 95% CI, 1.1-2.3), non-steroidal anti-inflammatory drugs (NSAIDs; OR, 1.64, 95% CI, 1.2-2.2), and selective serotonin reuptake inhibitors (SSRIs; OR, 1.74, 95% CI, 1.2-2.5). Symptoms were not associated with villus atrophy after adjusting for covariates. Conclusions A majority of symptomatic coeliac disease patients did not have active disease on follow-up histology. Symptoms were poorly predictive of persistent mucosal injury. The impact of NSAIDs, PPIs, and SSRIs on mucosal healing in coeliac disease warrants further study.
RCT Entities:
BACKGROUND:Duodenal injury persists in some coeliac diseasepatients despite gluten-free diet, and is associated with adverse outcomes. AIM: To determine the prevalence and clinical risk factors for persistent villus atrophy among symptomatic coeliac diseasepatients. METHODS: A nested cross-sectional analysis was performed on coeliac diseasepatients with self-reported moderate or severe symptoms while following a gluten-free diet, who underwent protocol-mandated duodenal biopsy upon enrolment in the CeliAction clinical trial. Demographic factors, symptom type, medication use, and serology were examined to determine predictors of persistent villus atrophy. RESULTS: Of 1345 symptomatic patients, 511 (38%, 95% CI, 35-41%) were found to have active coeliac disease with persistent villus atrophy, defined as average villus height to crypt depth ratio ≤2.0. On multivariable analysis, older age (OR, 5.1 for ≥70 vs. 18-29 years, 95% CI, 2.5-10.4) was a risk factor while longer duration on gluten-free diet was protective (OR, 0.37, 95% CI, 0.24-0.55 for 4-5.9 vs. 1-1.9 years). Villus atrophy was associated with use of proton-pump inhibitors (PPIs; OR, 1.6, 95% CI, 1.1-2.3), non-steroidal anti-inflammatory drugs (NSAIDs; OR, 1.64, 95% CI, 1.2-2.2), and selective serotonin reuptake inhibitors (SSRIs; OR, 1.74, 95% CI, 1.2-2.5). Symptoms were not associated with villus atrophy after adjusting for covariates. Conclusions A majority of symptomatic coeliac diseasepatients did not have active disease on follow-up histology. Symptoms were poorly predictive of persistent mucosal injury. The impact of NSAIDs, PPIs, and SSRIs on mucosal healing in coeliac disease warrants further study.
Authors: Benjamin A Lerner; Lynn T Phan Vo; Shireen Yates; Andrew G Rundle; Peter H R Green; Benjamin Lebwohl Journal: Am J Gastroenterol Date: 2019-05 Impact factor: 10.864
Authors: Jonas F Ludvigsson; Carolina Ciacci; Peter Hr Green; Katri Kaukinen; Ilma R Korponay-Szabo; Kalle Kurppa; Joseph A Murray; Knut Erik Aslaksen Lundin; Markku J Maki; Alina Popp; Norelle R Reilly; Alfonso Rodriguez-Herrera; David S Sanders; Detlef Schuppan; Sarah Sleet; Juha Taavela; Kristin Voorhees; Marjorie M Walker; Daniel A Leffler Journal: Gut Date: 2018-02-13 Impact factor: 23.059
Authors: Zsolt Szakács; Noémi Gede; Zoltán Gyöngyi; Margit Solymár; Dezső Csupor; Bálint Erőss; Áron Vincze; Alexandra Mikó; Andrea Vasas; László Szapáry; Dalma Dobszai; Viktória Balikó; Roland Hágendorn; Péter Hegyi; Judit Bajor Journal: Front Physiol Date: 2019-11-19 Impact factor: 4.566