Predictors of persistent villous atrophy in coeliac disease: a population-based study

Aliment Pharmacol Ther. 2014 Mar;39(5):488-95. doi: 10.1111/apt.12621. Epub 2014 Jan 16.


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 2 years compared to 56% among those ≥70 years). In contrast, persistent VA did not vary widely by age in earlier years. On multivariate analysis (restricted to the calendar period 2000-2008, 2-5 years 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. <2 years 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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Atrophy / epidemiology
  • Atrophy / pathology
  • Biopsy
  • Celiac Disease / diet therapy
  • Celiac Disease / epidemiology
  • Celiac Disease / pathology*
  • Child
  • Child, Preschool
  • Diet, Gluten-Free
  • Duodenum / pathology*
  • Female
  • Humans
  • Infant
  • Intestinal Mucosa / pathology*
  • Male
  • Microvilli / pathology*
  • Middle Aged
  • Prevalence
  • Sweden / epidemiology
  • Wound Healing
  • Young Adult