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 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.