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Intestinal Damage from Celiac Disease Persists in Adults, Even with Gluten-free Diet

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For adults with celiac disease, treatment with a gluten-free diet will begin to reduce symptoms such as diarrhea and weight loss within weeks. However, recovery from damage to mucosal tissue that lines the small intestine is much slower. Recent research supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) shows that for many adults with celiac disease, tissue damage persists after 5 years of adherence to a gluten-free diet.

“Good adherence to a gluten-free diet is necessary for mucosal recovery, but doesn’t guarantee mucosal recovery in all adults with celiac disease. Mucosal recovery did not occur in a substantial portion of adults with celiac disease for years after diagnosis. The rate of confirmed recovery was only 34 percent at 2 years,” wrote Joseph A. Murray, M.D., of the Mayo Clinic College of Medicine in Rochester, MN. After 5 years on a gluten-free diet, Murray noted, one in three adults with celiac disease still showed intestinal damage. The research findings were reported in the advance online issue of The American Journal of Gastroenterology.

Murray and five colleagues from the Mayo Clinic studied the effect of a gluten-free diet on mucosal tissue recovery in a group of 241 adults—176 women and 65 men with an average age of 47—with celiac disease, which had been confirmed by intestinal biopsy. The patients also had follow-up biopsies 2 years and 5 years after diagnosis.

The researchers couldn’t identify a common risk factor or other reason why some patients experienced recovery from tissue damage within 2 years, while the condition persisted much longer in others. Overall, the patients in the study had a 66 percent rate of good adherence to a gluten-free diet—determined through interviews with dietitians—a rate that matches the overall adult rate seen in other studies. For most patients in the study, a gluten-free diet eliminated clinical symptoms such as diarrhea and weight loss. However, only 43 percent of patients who maintained good dietary adherence achieved mucosal recovery. One possible cause of this result, the research group suggested, is inadvertent gluten ingestion from a source that is difficult to identify. “These findings further support the urgent necessity of standard labeling for gluten-free foods in the United States,” the researchers wrote.

A second objective of the study was to evaluate the effect of persistent intestinal damage on patients’ long-term health. The researchers found that regardless of age or sex, adults with celiac disease whose intestinal tissues experienced recovery were less likely to die from all causes than were men and women with persistent damage. “Achievement of mucosal recovery after treatment with a gluten-free diet in adults with celiac disease may be associated with a better survival compared with patients with persistent mucosal damage. Systematic follow-up with intestinal biopsies may be advisable in patients diagnosed with celiac disease as adults,” the researchers concluded.

More information about research projects funded by the National Institutes of Health can be found by using the Research Portfolio Online Reporting Tools (RePORT) Expenditures and Results (RePORTER) tool located at The research described in this article is funded under NIDDK grant number 5R01DK057892–08.

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Page last updated September 24, 2014


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