Predictors of persistent villous atrophy in coeliac disease: a population-based study
2014 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 39, no 5, 488-495 p.Article in journal (Refereed) Published
Background: Villous atrophy (VA) with intraepithelial lymphocytosis is the histological hallmark of coeliac disease (CD), but reported rates of mucosal recovery are variable.
Aim: To determine the impact of age and other demographic variables on the probability of persistent VA on follow-up biopsy.
Methods: We 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.
Results: Of 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).
Conclusions: The 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.
Place, publisher, year, edition, pages
Wiley-Blackwell, 2014. Vol. 39, no 5, 488-495 p.
Gastroenterology and Hepatology Pharmacology and Toxicology
IdentifiersURN: urn:nbn:se:oru:diva-56577DOI: 10.1111/apt.12621ISI: 000330564900004PubMedID: 24428688ScopusID: 2-s2.0-84893806546OAI: oai:DiVA.org:oru-56577DiVA: diva2:1082971