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. 2021 Feb 12;13(2):600.
doi: 10.3390/nu13020600.

Relationship between Persistent Gastrointestinal Symptoms and Duodenal Histological Findings after Adequate Gluten-Free Diet: A Gray Area of Celiac Disease Management in Adult Patients

Gloria Galli  1 , Marilia Carabotti  1 , Emanuela Pilozzi  2 , Edith Lahner  1 , Bruno Annibale  1 , Laura Conti  1
Affiliations

Relationship between Persistent Gastrointestinal Symptoms and Duodenal Histological Findings after Adequate Gluten-Free Diet: A Gray Area of Celiac Disease Management in Adult Patients

Gloria Galli et al. Nutrients. .

Abstract

A gluten-free diet (GFD) leads to a rapid improvement in gastrointestinal (GI) symptoms, biochemical alterations and duodenal histological damage in the majority of celiac disease (CD) patients. This study aimed to assess the frequency and factors associated with the persistence of GI symptoms/malabsorption signs and their relationship with duodenal histological findings among CD patients on an adequate GFD (mean duration 16 months, range 12-28 months). This longitudinal cohort study included 102 adult CD patients (median age 38.5 years, range 18-76 years, F = 71.6%) diagnosed between 2012 and 2018. A total of 36.3% of the included patients had persistent GI symptoms and/or malabsorption signs (Group 1), while the remaining patients had complete GI well-being without malabsorption signs (Group 2) at the time of histological re-evaluation. The persistence of GI symptoms/signs was associated with a long duration of symptoms/signs before CD diagnosis (≥5 years) (OR 5.3; 95% CI 1.3-21.8) and the presence of constipation at the time of CD diagnosis (OR 7.5; 95% CI 1.3-42) while for other variables, including age at CD diagnosis, sex, duration of GFD, comorbidities, CD serology positivity and severity of duodenal damage at histological re-evaluation, no association was found. According to our results, the persistence of symptoms/signs is not associated with histological findings, and their relationship could be a gray area in CD management.

Keywords: celiac disease; duodenal histology; gastrointestinal symptoms; gluten-free diet; malabsorption signs; slow responders.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of study population. CD = Celiac Disease; GI = Gastrointestinal; GFD = Gluten-free diet.
Figure 2
Figure 2
Trend of GI symptoms among patients with persistent GI symptoms/signs at the time of the histological re-evaluation. GFD = Gluten-free diet; Ns = Not significant.
See this image and copyright information in PMC

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