Inadvertent gluten exposure tied to persistent villous atrophy in coeliac disease patients

Adult patients with coeliac disease who are on an intentionally strict gluten-free diet have high rates of persistent villous atrophy after 2 years, a study has found. Low-level ongoing inadvertent gluten exposure is a potential contributing factor to persistent villous atrophy.

“A substantial proportion of adult patients with coeliac disease on a gluten-free diet exhibit persistent villous atrophy, and inadvertent gluten exposure may be one of the causes,” the authors said.

To test this hypothesis, symptomatic de novo adult patients with coeliac disease were prospectively enrolled in this study. Clinical visits and dietary surveillance were scheduled every 6 months during a 2-year follow-up period.

At each visit, the authors collected and stored faecal samples at –20 °C until analysis for gluten immunogenic peptides (f-GIPs). They performed a follow-up duodenal biopsy at 2 years and examined the variables associated with persistent villous atrophy.

Seventy-six patients (mean age 36.5 years, 73 percent women) completed the study, among whom 53 percent had persistent villous atrophy, while 72.5 percent were asymptomatic, and 75 percent had negative serology.

Sixty-nine percent of patients had detectable f-GIP >0.08 μg/g in at least one faecal sample. No significant differences were noted in the median f-GIP at each visit and median area under the curve over the serial measurements between patients with persistent atrophy and those who recovered.

Multivariate analysis revealed that only older age was associated with persistent villous atrophy (32 percent for 16–30 years; 67 percent for >30 years; p=0.016).