Histological recovery and gluten‐free diet adherence: a prospective 1‐year follow‐up study of adult patients with coeliac disease

Summary Background Adequate gluten‐free diet ( GFD ) is the only treatment for coeliac disease ( CD ). However, no agreement has been reached on either how and when to assess patient adherence to GFD or its effectiveness on villous atrophy. Aim To assess, in a prospective study, patient adherence to and efficacy of GFD on histological recovery after 1‐year of GFD . Methods Between 2009 and 2012, we enrolled 65 consecutive newly‐diagnosed adult patients (median age 38 years, 18–70) with biopsy‐proven atrophic CD . Patients were re‐evaluated after 1 year of GFD with duodenal histology, serological assays, symptoms and a dietary interview based on a validated questionnaire. Complete histological recovery was defined as the absence of villous atrophy and ≤30/100 intraepithelial lymphocytes. Results Overall, 81.5% of patients had adequate adherence ( ADA ) to GFD , whereas 18.5% had an inadequate adherence ( IADA ); 66% of ADA patients and no IADA patients achieved complete histological recovery ( P  < 0.00001). Among ADA patients, antibody seroconversion and symptoms were not significantly different between patients who achieved complete histological recovery and those who achieved partial histological recovery with P  = 0.309 and P  = 0.197, respectively. Multivariate analysis showed that Marsh 3C was a risk factor for incomplete histological recovery in ADA patients ( OR 8.74, 95% CI : 1.87–40.83). Conclusions This study shows that complete histological recovery after 1‐year of GFD in adult patients, who are assessed as adherent to the GFD , can be obtained in 66% of patients. Patients with severe histological damage at diagnosis are at risk for incomplete histological recovery 1 year later.