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Mucosal healing and mortality in coeliac disease.
Aliment Pharmacol Ther 2013; 37(3):332-9AP

Abstract

BACKGROUND

Coeliac disease (CD), characterised by the presence of villous atrophy (VA) in the small intestine, is associated with increased mortality, but it is unknown if mortality is influenced by mucosal recovery.

AIMS

To determine whether persistent VA is associated with mortality in CD.

METHODS

Through biopsy reports from all pathology departments (n = 28) in Sweden, we identified 7648 individuals with CD (defined as VA) who had undergone a follow-up biopsy within 5 years following diagnosis. We used Cox regression to examine mortality according to follow-up biopsy.

RESULTS

The mean age of CD diagnosis was 28.4; 63% were female; and the median follow-up after diagnosis was 11.5 years. The overall mortality rate of patients who underwent follow-up biopsy was lower than that of those who did not undergo follow-up biopsy (Hazard Ratio 0.88, 95% CI: 0.80-0.96). Of the 7648 patients who underwent follow-up biopsy, persistent VA was present in 3317 (43%). There were 606 (8%) deaths. Patients with persistent VA were not at increased risk of death compared with those with mucosal healing (HR: 1.01; 95% CI: 0.86-1.19). Mortality was not increased in children with persistent VA (HR: 1.09 95% CI: 0.37-3.16) or adults (HR 1.00 95% CI: 0.85-1.18), including adults older than age 50 years (HR: 0.96 95% CI: 0.80-1.14).

CONCLUSIONS

Persistent villous atrophy is not associated with increased mortality in coeliac disease. While a follow-up biopsy will allow detection of refractory disease in symptomatic patients, in the select population of patients who undergo repeat biopsy, persistent villous atrophy is not useful in predicting future mortality.

Authors+Show Affiliations

Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23190299

Citation

Lebwohl, B, et al. "Mucosal Healing and Mortality in Coeliac Disease." Alimentary Pharmacology & Therapeutics, vol. 37, no. 3, 2013, pp. 332-9.
Lebwohl B, Granath F, Ekbom A, et al. Mucosal healing and mortality in coeliac disease. Aliment Pharmacol Ther. 2013;37(3):332-9.
Lebwohl, B., Granath, F., Ekbom, A., Montgomery, S. M., Murray, J. A., Rubio-Tapia, A., ... Ludvigsson, J. F. (2013). Mucosal healing and mortality in coeliac disease. Alimentary Pharmacology & Therapeutics, 37(3), pp. 332-9. doi:10.1111/apt.12164.
Lebwohl B, et al. Mucosal Healing and Mortality in Coeliac Disease. Aliment Pharmacol Ther. 2013;37(3):332-9. PubMed PMID: 23190299.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mucosal healing and mortality in coeliac disease. AU - Lebwohl,B, AU - Granath,F, AU - Ekbom,A, AU - Montgomery,S M, AU - Murray,J A, AU - Rubio-Tapia,A, AU - Green,P H R, AU - Ludvigsson,J F, Y1 - 2012/11/28/ PY - 2012/06/10/received PY - 2012/06/28/revised PY - 2012/10/22/revised PY - 2012/11/05/accepted PY - 2012/11/30/entrez PY - 2012/11/30/pubmed PY - 2013/6/25/medline SP - 332 EP - 9 JF - Alimentary pharmacology & therapeutics JO - Aliment. Pharmacol. Ther. VL - 37 IS - 3 N2 - BACKGROUND: Coeliac disease (CD), characterised by the presence of villous atrophy (VA) in the small intestine, is associated with increased mortality, but it is unknown if mortality is influenced by mucosal recovery. AIMS: To determine whether persistent VA is associated with mortality in CD. METHODS: Through biopsy reports from all pathology departments (n = 28) in Sweden, we identified 7648 individuals with CD (defined as VA) who had undergone a follow-up biopsy within 5 years following diagnosis. We used Cox regression to examine mortality according to follow-up biopsy. RESULTS: The mean age of CD diagnosis was 28.4; 63% were female; and the median follow-up after diagnosis was 11.5 years. The overall mortality rate of patients who underwent follow-up biopsy was lower than that of those who did not undergo follow-up biopsy (Hazard Ratio 0.88, 95% CI: 0.80-0.96). Of the 7648 patients who underwent follow-up biopsy, persistent VA was present in 3317 (43%). There were 606 (8%) deaths. Patients with persistent VA were not at increased risk of death compared with those with mucosal healing (HR: 1.01; 95% CI: 0.86-1.19). Mortality was not increased in children with persistent VA (HR: 1.09 95% CI: 0.37-3.16) or adults (HR 1.00 95% CI: 0.85-1.18), including adults older than age 50 years (HR: 0.96 95% CI: 0.80-1.14). CONCLUSIONS: Persistent villous atrophy is not associated with increased mortality in coeliac disease. While a follow-up biopsy will allow detection of refractory disease in symptomatic patients, in the select population of patients who undergo repeat biopsy, persistent villous atrophy is not useful in predicting future mortality. SN - 1365-2036 UR - https://www.unboundmedicine.com/medline/citation/23190299/Mucosal_healing_and_mortality_in_coeliac_disease_ L2 - https://doi.org/10.1111/apt.12164 DB - PRIME DP - Unbound Medicine ER -