Celiac Disease

CD: Villous Atrophy (2006)

• Intervention
  What is the long-term effectiveness in people with celiac disease of following a gluten-free dietary pattern on villous atrophy?

  • Conclusion

    Several studies report that individuals who are compliant with a gluten-free dietary pattern have substantial improvement in villous atrophy; however, mucosal abnormalities may persist in some individuals.  Normalization of abnormalities may occur within 1 year, but generally takes longer, depending on the severity of villous atrophy, level of dietary compliance and age at diagnosis.  One study indicated that recovery in children may progress faster and more completely than in adults.  Several studies report that improvement in villous atrophy is not dependent on the type of gluten-free dietary pattern (wheat starch-based or naturally gluten-free); however, villous atrophy is significantly associated with dietary compliance.  Further research is needed to determine the factors involved with the persistence of mucosal abnormalities in those adhering to a gluten-free dietary pattern.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the long-term effectiveness of following a gluten-free dietary pattern on villous atrophy?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Ciacci C, Cirillo M, Cavallaro R, Mazzacca G.  Long-term follow-up of celiac adults on gluten-free diet:  prevalence and correlates of intestinal damage.  Digestion 2002; 66(3): 178-185.
      • Ciacci C, Iovino P, Amoruso D, Siniscalchi M, Tortora R, Di Gilio A, Fusco M, Mazzacca G.  Grown-up celiac children:  the effects of only a few years on a gluten-free diet in childhood.  Aliment Pharmacol Ther 2005; 21(4): 421-429.
      • Dickey W, Hughes DF, McMillan SA.  Disappearance of endomysial antibodies in treated celiac disease does not indicate histological recovery.  Am J Gastroenterol 2000; 95(3): 712-714.
      • Hogberg L, Laurin P, Falth-Magnusson K, Grant C, Grodzinsky E, Jansson G, Ascher H, Browaldh L, Hammersjo JA, Lindberg E, Myrdal U, Stenhammar L. Oats to children with newly diagnosed celiac disease: a randomized double blind study. Gut 2004; 53:649-654.
      • Janatuinen EK, Kemppainen TA, Julkunen RJK, Kosma VM, Maki M, Heikkinen M, Uusitupa MIJ. No harm from five year ingestion of oats in celiac disease. Gut 2002; 50: 332-335. 
      • Janatuinen EK, Kemppainen TA, Pikkarainen PH, Holm KH, Kosma VM, Uusitupa MIJ, Maki M, Julkunen RJK. Lack of cellular and humoral immunological responses to oats in adults with celiac disease. Gut 2000; 46: 327-331.
      • Janatuinen EK, Pikkarainen PH, Kemppainen TA, Kosma VM, Jarvinen RMK, Uusitupa MIJ, Julkunen RJK. A comparison of diets with and without oats in adults with celiac disease. N Engl J Med 1995; 333: 1033-7.
      • Kaukinen K, Collin P, Holm K, Rantala I, Vuolteenaho N, Reunala T, Maki M. Wheat starch-containing gluten-free flour products in the treatment of coeliac disease and dermatitis herpetiformis. A long-term follow-up study.  Scand J Gastroenterol 1999; 34: 163-169. 
      • Kaukinen K, Sulkanen S, Maki M, Collin P.  IgA-class transglutaminase antibodies in evaluating the efficacy of gluten-free diet in celiac disease.  Eur J Gastroenterol Hepatol 2002; 14(3): 311-315. 
      • Kemppainen TA, Kosma VM, Janatuinen EK, Julkunen RJ, Pikkarainen PH, Uusitupa MI.  Nutritional status of newly diagnosed celiac disease patients before and after the institution of a celiac disease diet - association with the grade of mucosal villous atrophy.  Am J Clin Nutr 1998; 67(3): 482-487.
      • Lee SK, Lo W, Memeo L, Rotterdam H, Green PH.  Duodenal histology in patients with celiac disease after treatment with a gluten-free diet.  Gastrointest Endosc 2003; 57(2): 187-191.
      • Lohiniemi S, Maki M, Kaukinen K, Laippala P, Collin P. Gastrointestinal symptoms rating scale in coeliac disease patients on wheat starch-based gluten-free diets. Scand J Gastroenterol 2000; 35:947-949.
      • Peraaho M, Kaukinen K, Paasikivi K, Sievanen H, Lohiniemi S, Maki M, Collin P. Wheat-starch-based gluten-free products in the treatment of newly detected coeliac disease: Prospective and randomized study. Aliment Pharmacol Ther 2003; 17:587-594. 
      • Peraaho M, Kaukinen K, Mustalahti K, Vuolteenaho N, Maki M, Laippala P, Collin P. Effect of an oats-containing gluten-free diet on symptoms and quality of life in celiac disease. A randomized study.  Scand J Gastroenterol 2004; 39:27-31.
      • Selby WS, Painter D, Collins A, Faulkner-Hogg KB, Loblay RH. Persistent mucosal abnormalities in coeliac disease are not related to the ingestion of trace amounts of gluten. Scand J Gastroenterol 1999; 34: 909-914.
      • Wahab PJ, Meijer JWR, Mulder CJJ.  Histologic follow-up of people with celiac disease on a gluten-free diet:  slow and incomplete recovery.  Am J Clin Pathol 2002; 118(3): 459-463.
  • Search Plan and Results: CD: Villous Atrophy 2007