Auteur Topic: Factors associated with villus atrophy in symptomatic coeliac disease patients o  (gelezen 472 keer)


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Wiley Online Library
Alimentary Pharmacology & Therapeutics

April 2017

Factors associated with villus atrophy in symptomatic coeliac disease patients on a gluten-free diet

Mahadev S1, Murray JA2, Wu TT3, Chandan VS3, Torbenson MS3, Kelly CP4, Maki M5, Green PH1, Adelman D6, Lebwohl B1.

1 Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, USA.
2 Division of Gastroenterology and Hepatology, The Mayo Clinic, Rochester, MN, USA.
3 Department of Laboratory Medicine and Pathology, The Mayo Clinic, Rochester, MN, USA.
4 Celiac Center, Beth Israel Deaconess Medical Center and Celiac Research Program, Harvard Medical School, Boston, MA, USA.
5 Tampere Center for Child Health Research, School of Medicine, University of Tampere and Tampere University Hospital,
   Finland, Europe.
6 Division of Allergy/Immunology, Department of Medicine, University of California, San Francisco, CA, USA.

Duodenal injury persists in some coeliac disease patients despite gluten-free diet, and is associated with adverse outcomes.

To determine the prevalence and clinical risk factors for persistent villus atrophy among symptomatic coeliac disease patients.

A nested cross-sectional analysis was performed on coeliac disease patients with self-reported moderate or severe symptoms while following a gluten-free diet, who underwent protocol-mandated duodenal biopsy upon enrolment in the CeliAction clinical trial.
Demographic factors, symptom type, medication use, and serology were examined to determine predictors of persistent villus atrophy.

Of 1345 symptomatic patients, 511 (38%, 95% CI, 3541%) were found to have active coeliac disease with persistent villus atrophy, defined as average villus height to crypt depth ratio ≤2.0. On multivariable analysis, older age (OR, 5.1 for ≥70 vs. 1829 years, 95% CI, 2.510.4) was a risk factor while longer duration on gluten-free diet was protective (OR, 0.37, 95% CI, 0.240.55 for 45.9 vs. 11.9 years).

Villus atrophy was associated with use of proton-pump inhibitors (PPIs; OR, 1.6, 95% CI, 1.12.3), non-steroidal anti-inflammatory drugs (NSAIDs; OR, 1.64, 95% CI, 1.22.2), and selective serotonin reuptake inhibitors (SSRIs; OR, 1.74, 95% CI, 1.22.5).
Symptoms were not associated with villus atrophy after adjusting for covariates.

A majority of symptomatic coeliac disease patients did not have active disease on follow-up histology. Symptoms were poorly predictive of persistent mucosal injury.
The impact of NSAIDs, PPIs, and SSRIs on mucosal healing in coeliac disease warrants further study.

Table 1.
Characteristics of patients with coeliac disease and persistent symptoms (n = 1345) who underwent duodenal biopsy

Table 2.
Demographics and persistent villus atrophy (VH:CD ≤2)

Figure 1.
Prevalence of villus atrophy among 1345 coeliac disease patients with persistent symptoms, grouped by duration on a gluten-free diet.

Table 3.
Univariate analysis of symptoms and medication use with persistent villus atrophy (VH:CD ≤2)
Table 4. Laboratory tests and persistent villus atrophy (VH:CD ≤2)
Elevated serum level  / Normal serum level
Met de leverenzymen:  AST / ALT / GGT /ALKALINE FOSFATASE           

Table 5.
Multiple logistic regression of factors associated with persistent villus atrophy (VH:CD ≤2)
Male sex /  Duration on gluten-free diet in years /  Symptoms

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Mijn zoon (20) en ik eten allebei glutenvrij. Wij zijn extreem gevoelig voor sporen van gluten (via besmetting, tarwe-derivaten en hulpstoffen). Ik ben wetenschapsredacteur voor het Glutenvrij Magazine van de NCV.