Predictive Factors and Clinical Impact of Deep Remission in Celiac Disease

• Type: Article in International Scientific Journal
• Date: 2020

Authors

Silva, M (Author) Other; Peixoto, A (Author) Other; Santos, AL (Author) Other; Costa Moreira, P (Author) Other; da Silva, JF (Author) Other; Dias, E (Author) Other; Macedo G (Author) FMUP

Journal

Title: GE Portuguese Journal Of Gastroenterology

Vol. 27

Pages: 304-311

ISSN: 2341-4545

Publisher: Karger

Indexing

ISI Web of Knowledge - 5 Citations

Scopus - 5 Citations

Other information

Authenticus ID: P-00R-NXM

DOI: 10.1159/000505035

Abstract (EN): Introduction: The ultimate indicator of adherence to a gluten-free diet is the demonstration of mucosal healing. However, the need for histological reassessment is subject to controversy among "experts". The aim of this study was to evaluate celiac patients who underwent histological reevaluation after starting a gluten-free diet in order to identify those with histological remission and associated factors. Methods: This retrospective study included patients who agreed to a histological reassessment after apparent clinical and serological remission and reported at least 12 months of diet adherence. In all cases, informed consent was signed for upper endoscopy. Results: A total of 69 patients were included. In 67.9% of cases, the diagnosis was made in the context of "classic" symptomatology, 17% had "nonclassical" presentation, and 15.1% were in latent phase. 69.2% of the diagnoses were initially suspected by serology. Endoscopically, 11.8% of the patients did not present suggestive features macroscopically, and a histological grade of Marsh IIIa-c was observed in 75.5% of all cases. The histological findings were normalized in 37.7%, which was associated with the presence of lower Marsh score values at diagnosis (p = 0.014) and lower DEXA T-score values (p = 0.038). A histological improvement was observed in 55 patients (>= 2 grades in 37 cases), which was related to the initial transferrin saturation (p = 0.027) and with higher Marsh scores at diagnosis (p = 0.007). Conclusion: Even under a gluten-free diet, celiac histology normalization is difficult to obtain and appears to be independent of most clinical and serological findings at diagnosis. Patients with less severe histological levels at diagnosis reach remission more easily, but only represent the minority of the population.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 8