期刊
ALIMENTARY PHARMACOLOGY & THERAPEUTICS
卷 39, 期 5, 页码 488-495出版社
WILEY-BLACKWELL
DOI: 10.1111/apt.12621
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资金
- American Scandinavian Foundation
- Celiac Sprue Association
- National Center for Advancing Translational Sciences, National Institutes of Health [UL1 TR000040]
- National Institutes of Health [DK057892]
- American College of Gastroenterology Junior Faculty Development Award
- Orebro University Hospital, Karolinska Institutet
- Swedish Society of Medicine
- Swedish Research Council - Medicine [522-2A09-195]
- Swedish Celiac Society
BackgroundVillous atrophy (VA) with intraepithelial lymphocytosis is the histological hallmark of coeliac disease (CD), but reported rates of mucosal recovery are variable. AimTo determine the impact of age and other demographic variables on the probability of persistent VA on follow-up biopsy. MethodsWe identified patients with VA on duodenal histology at all 28 Swedish pathology departments during the years spanning 1969-2008. We examined age, gender, calendar period, duration of disease and educational attainment to determine predictors of persistent VA. ResultsOf 7648 patients with CD who underwent follow-up biopsy, persistent VA was present in 3317 (43%; 95% CI 42-44%). The effect of age on persistent VA varied according to time period; among those biopsied in the years spanning 2000-2008, the prevalence of persistent VA was 31%, and increasing age was associated with increasing rates of persistent VA (17% among those younger than 2years compared to 56% among those 70years). In contrast, persistent VA did not vary widely by age in earlier years. On multivariate analysis (restricted to the calendar period 2000-2008, 2-5years after CD diagnosis), persistent VA was more common among males (OR 1.43; 95% CI 1.07-1.90) and less common among patients with higher educational attainment (OR for college degree vs. <2years of high school 0.52, 95% CI 0.35-0.78). ConclusionsThe prevalence of persistent villous atrophy has changed over time, with greater rates of healing in recent years. Social differences in persistent villous atrophy suggest that access and/or education regarding the gluten-free diet impact mucosal healing.
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