Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Jul 20;14(14):5144.
doi: 10.3390/jcm14145144.

Outcomes in Adults with Celiac Disease Following a Gluten-Free Diet

Daniel Vasile Balaban  1   2 , Iulia Enache  1   2 , Marina Balaban  1   2 , Răzvan Andrei David  1   2 , Andreea-Diana Vasile  3 , Alina Popp  1   3   4 , Mariana Jinga  1   2
Affiliations
Review

Outcomes in Adults with Celiac Disease Following a Gluten-Free Diet

Daniel Vasile Balaban et al. J Clin Med. .

Abstract

Background/Objectives: Histological follow-up still lacks consensus in the long-term management of adult patients with celiac disease (CD) adhering to a gluten-free diet (GFD). Despite clinical and serological improvement, a significant proportion of patients continue to have persistent villous atrophy. We aimed to synthesize current evidence regarding histological outcomes after GFD treatment in adult CD, focusing on mucosal healing rates, assessment methods, and remission criteria. Methods: We conducted a literature search with extraction and analysis of published cohort studies that included adult patients with CD on GFD with follow-up biopsy data. Extracted parameters included demographic details, baseline histology, GFD duration and adherence, serologic status, and histologic recovery rates with corresponding remission criteria. Results: Data from 46 studies comprising 15,530 patients were analyzed. The overall mean age was 41 years, and 73.3% were female. Mean histologic remission across cohorts was 58.8%, with considerable interstudy variation. Remission criteria also varied widely, ranging from strict Marsh 0 control histology to more inclusive definitions that considered Marsh 1 or even non-atrophic mucosa (Marsh < 3) as indicative of recovery, while some studies relied on quantitative villous height-to-crypt depth ratio thresholds, substantially influencing reported remission rates. Longer GFD duration and rigorous diet adherence assessment using validated questionnaires and accurate laboratory tools were associated with higher remission rates. Conclusions: Histologic remission in GFD-treated adult patients with CD is highly variable and strongly influenced by remission definitions and adherence assessment methods. Standardized reporting using validated metrics for histologic outcome and dietary compliance is essential for harmonizing follow-up strategies in adult CD.

Keywords: GFD-treated; celiac disease; follow-up; histology; persistent; recovery; remission; villous atrophy.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of study identification, screening, and selection.
Figure 2
Figure 2
Spectrum of gluten-induced mucosal injury in CD and subsequent mucosal recovery after dietary gluten exclusion.
Figure 3
Figure 3
Remission rates according to Marsh 0 vs. Marsh 1 thresholds [16,46,52,54].
See this image and copyright information in PMC

References

    1. Singh P., Arora A., Strand T.A., Leffler D.A., Catassi C., Green P.H., Kelly C.P., Ahuja V., Makharia G.K. Global Prevalence of Celiac Disease: Systematic Review and Meta-Analysis. Clin. Gastroenterol. Hepatol. 2018;16:823–836.e2. doi: 10.1016/j.cgh.2017.06.037. - DOI - PubMed
    1. Al-Toma A., Volta U., Auricchio R., Castillejo G., Sanders D.S., Cellier C., Mulder C.J., Lundin K.E.A. European Society for the Study of Coeliac Disease (ESsCD) Guideline for Coeliac Disease and Other Gluten-Related Disorders. United Eur. Gastroenterol. J. 2019;7:583–613. doi: 10.1177/2050640619844125. - DOI - PMC - PubMed
    1. Mulder C.J.J., Elli L., Lebwohl B., Makharia G.K., Rostami K., Rubio-Tapia A., Schumann M., Tye-Din J., Zeitz J., Al-Toma A. Follow-Up of Celiac Disease in Adults: “When, What, Who, and Where”. Nutrients. 2023;15:2048. doi: 10.3390/nu15092048. - DOI - PMC - PubMed
    1. Segura V., Ruiz-Carnicer Á., Sousa C., Moreno M.D.L. New Insights into Non-Dietary Treatment in Celiac Disease: Emerging Therapeutic Options. Nutrients. 2021;13:2146. doi: 10.3390/nu13072146. - DOI - PMC - PubMed
    1. Rubio-Tapia A., Hill I.D., Semrad C., Kelly C.P., Greer K.B., Limketkai B.N., Lebwohl B. American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease. Am. J. Gastroenterol. 2023;118:59. doi: 10.14309/ajg.0000000000002075. - DOI - PubMed

LinkOut - more resources