396 Mucosal Healing and Mortality in Celiac Disease

Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
Alimentary Pharmacology & Therapeutics (Impact Factor: 5.73). 11/2012; 37(3). DOI: 10.1111/apt.12164
Source: PubMed


BACKGROUND: Coeliac disease (CD), characterised by the presence of villous atrophy (VA) in the small intestine, is associated with increased mortality, but it is unknown if mortality is influenced by mucosal recovery. AIMS: To determine whether persistent VA is associated with mortality in CD. METHODS: Through biopsy reports from all pathology departments (n = 28) in Sweden, we identified 7648 individuals with CD (defined as VA) who had undergone a follow-up biopsy within 5 years following diagnosis. We used Cox regression to examine mortality according to follow-up biopsy. RESULTS: The mean age of CD diagnosis was 28.4; 63% were female; and the median follow-up after diagnosis was 11.5 years. The overall mortality rate of patients who underwent follow-up biopsy was lower than that of those who did not undergo follow-up biopsy (Hazard Ratio 0.88, 95% CI: 0.80-0.96). Of the 7648 patients who underwent follow-up biopsy, persistent VA was present in 3317 (43%). There were 606 (8%) deaths. Patients with persistent VA were not at increased risk of death compared with those with mucosal healing (HR: 1.01; 95% CI: 0.86-1.19). Mortality was not increased in children with persistent VA (HR: 1.09 95% CI: 0.37-3.16) or adults (HR 1.00 95% CI: 0.85-1.18), including adults older than age 50 years (HR: 0.96 95% CI: 0.80-1.14). CONCLUSIONS: Persistent villous atrophy is not associated with increased mortality in coeliac disease. While a follow-up biopsy will allow detection of refractory disease in symptomatic patients, in the select population of patients who undergo repeat biopsy, persistent villous atrophy is not useful in predicting future mortality.

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Available from: Peter H R Green, Oct 13, 2014
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    • "Another study with children is of limited value in the aspect that only seroconverted children were included [29]. Then, in contrast to the current study, most of the studies reporting on correlations between follow-up histology and serologies are retrospective [2,26,28,29]. Another strength of the current study was the cut-off point being adjusted for the study population in case of all antibody tests according to ROC analysis (Table 1). "
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    ABSTRACT: In diagnosing celiac disease (CD), serological tests are highly valuable. However, their role in following up children with CD after prescription of a gluten-free diet is unclear. This study aimed to compare the performance of antibody tests in predicting small-intestinal mucosal status in diagnosis vs. follow-up of pediatric CD. We conducted a prospective cohort study at a tertiary-care center. 148 children underwent esophohagogastroduodenoscopy with biopsies either for symptoms +/- positive CD antibodies (group A; n = 95) or following up CD diagnosed >= 1 year before study enrollment (group B; n = 53). Using biopsy (Marsh >= 2) as the criterion standard, areas under ROC curves (AUCs) and likelihood-ratios were calculated to estimate the performance of antibody tests against tissue transglutaminase (TG2), deamidated gliadin peptide (DGP) and endomysium (EMA). AUCs were higher when tests were used for CD diagnosis vs. follow-up: 1 vs. 0.86 (P = 0,100) for TG2-IgA, 0.85 vs. 0.74 (P = 0,421) for TG2-IgG, 0.97 vs. 0.61 (P = 0,004) for DPG-IgA, and 0.99 vs. 0.88 (P = 0,053) for DPG-IgG, respectively. Empirical power was 85% for the DPG-IgA comparison, and on average 33% (range 13-43) for the non-significant comparisons. Among group B children, 88.7% showed mucosal healing (median 2.2 years after primary diagnosis). Only the negative likelihood-ratio of EMA was low enough (0.097) to effectively rule out persistent mucosal injury. However, out of 12 EMA-positive children with mucosal healing, 9 subsequently turned EMA-negative. Among the CD antibodies examined, negative EMA most reliably predict mucosal healing. In general, however, antibody tests, especially DPG-IgA, are of limited value in predicting the mucosal status in the early years post-diagnosis but may be sufficient after a longer period of time.
    BMC Gastroenterology 02/2014; 14(1):28. DOI:10.1186/1471‑230X‑14‑28 · 2.37 Impact Factor
    • "CD is also characterized by an increased mortality [225]. It is well known that this fact is mainly the result of the complications of CD itself, represented by refractory CD (RCD) and enteropathy-associated T-cell lymphoma (EATL) [226]. "
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    07/2013; 2013(9):127589. DOI:10.1155/2013/127589
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