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

S. Mahadev, Joseph A Murray, Tsung-Teh Wu, V. S. Chandan, Michael Torbenson, C. P. Kelly, M. Maki, P. H R Green, D. Adelman, B. Lebwohl

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

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
Volume45
Issue number8
DOIs
StatePublished - Apr 1 2017

Fingerprint

Gluten-Free Diet
Celiac Disease
Atrophy
Non-Steroidal Anti-Inflammatory Agents
Proton Pump Inhibitors
Wounds and Injuries
Serotonin Uptake Inhibitors
Serology
Histology
Anti-Inflammatory Agents
Cross-Sectional Studies
Demography
Clinical Trials
Biopsy
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Factors associated with villus atrophy in symptomatic coeliac disease patients on a gluten-free diet. / Mahadev, S.; Murray, Joseph A; Wu, Tsung-Teh; Chandan, V. S.; Torbenson, Michael; Kelly, C. P.; Maki, M.; Green, P. H R; Adelman, D.; Lebwohl, B.

In: Alimentary Pharmacology and Therapeutics, Vol. 45, No. 8, 01.04.2017, p. 1084-1093.

Research output: Contribution to journalArticle

Mahadev, S, Murray, JA, Wu, T-T, Chandan, VS, Torbenson, M, Kelly, CP, Maki, M, Green, PHR, Adelman, D & Lebwohl, B 2017, 'Factors associated with villus atrophy in symptomatic coeliac disease patients on a gluten-free diet', Alimentary Pharmacology and Therapeutics, vol. 45, no. 8, pp. 1084-1093. https://doi.org/10.1111/apt.13988
Mahadev, S. ; Murray, Joseph A ; Wu, Tsung-Teh ; Chandan, V. S. ; Torbenson, Michael ; Kelly, C. P. ; Maki, M. ; Green, P. H R ; Adelman, D. ; Lebwohl, B. / Factors associated with villus atrophy in symptomatic coeliac disease patients on a gluten-free diet. In: Alimentary Pharmacology and Therapeutics. 2017 ; Vol. 45, No. 8. pp. 1084-1093.
@article{61ccf6f448df49ebb5984e472de05427,
title = "Factors associated with villus atrophy in symptomatic coeliac disease patients on a gluten-free diet",
abstract = "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.",
author = "S. Mahadev and Murray, {Joseph A} and Tsung-Teh Wu and Chandan, {V. S.} and Michael Torbenson and Kelly, {C. P.} and M. Maki and Green, {P. H R} and D. Adelman and B. Lebwohl",
year = "2017",
month = "4",
day = "1",
doi = "10.1111/apt.13988",
language = "English (US)",
volume = "45",
pages = "1084--1093",
journal = "Alimentary Pharmacology and Therapeutics",
issn = "0269-2813",
publisher = "Wiley-Blackwell",
number = "8",

}

TY - JOUR

T1 - Factors associated with villus atrophy in symptomatic coeliac disease patients on a gluten-free diet

AU - Mahadev, S.

AU - Murray, Joseph A

AU - Wu, Tsung-Teh

AU - Chandan, V. S.

AU - Torbenson, Michael

AU - Kelly, C. P.

AU - Maki, M.

AU - Green, P. H R

AU - Adelman, D.

AU - Lebwohl, B.

PY - 2017/4/1

Y1 - 2017/4/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85013414361&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85013414361&partnerID=8YFLogxK

U2 - 10.1111/apt.13988

DO - 10.1111/apt.13988

M3 - Article

VL - 45

SP - 1084

EP - 1093

JO - Alimentary Pharmacology and Therapeutics

JF - Alimentary Pharmacology and Therapeutics

SN - 0269-2813

IS - 8

ER -