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

S. Mahadev, J. A. Murray, T. T. Wu, V. S. Chandan, M. S. Torbenson, C. P. Kelly, M. Maki, P. H.R. Green, D. Adelman, B. Lebwohl

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26 Scopus citations


Background: Duodenal injury persists in some coeliac disease patients despite gluten-free diet, and is associated with adverse outcomes. Aim: To determine the prevalence and clinical risk factors for persistent villus atrophy among symptomatic coeliac disease patients. Methods: 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. Results: Of 1345 symptomatic patients, 511 (38%, 95% CI, 35–41%) 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. 18–29 years, 95% CI, 2.5–10.4) was a risk factor while longer duration on gluten-free diet was protective (OR, 0.37, 95% CI, 0.24–0.55 for 4–5.9 vs. 1–1.9 years). Villus atrophy was associated with use of proton-pump inhibitors (PPIs; OR, 1.6, 95% CI, 1.1–2.3), non-steroidal anti-inflammatory drugs (NSAIDs; OR, 1.64, 95% CI, 1.2–2.2), and selective serotonin reuptake inhibitors (SSRIs; OR, 1.74, 95% CI, 1.2–2.5). Symptoms were not associated with villus atrophy after adjusting for covariates. Conclusions 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.

Original languageEnglish (US)
Pages (from-to)1084-1093
Number of pages10
JournalAlimentary Pharmacology and Therapeutics
Issue number8
StatePublished - Apr 1 2017

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology
  • Pharmacology (medical)


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