Younger age at diagnosis predisposes to mucosal recovery in celiac disease on a gluten-free diet: A meta-analysis

• Published in: PloS one Vol. 12; no. 11; p. e0187526
• Main Authors: Szakács, Zsolt, Mátrai, Péter, Hegyi, Péter, Szabó, Imre, Vincze, Áron, Balaskó, Márta, Mosdósi, Bernadett, Sarlós, Patrícia, Simon, Mária, Márta, Katalin, Mikó, Alexandra, Pécsi, Dániel, Demcsák, Alexandra, Bajor, Judit
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 02.11.2017; Public Library of Science (PLoS)
• Subjects: Adult; Adults; Age; Age Factors; Atrophy; Autoimmune diseases; Biology and Life Sciences; Biopsy; Celiac disease; Celiac Disease - diet therapy; Celiac Disease - pathology; Child; Child, Preschool; Children; Citation management software; Clinical medicine; Clinical trials; Confidence intervals; Diagnosis; Diagnostic systems; Diet; Diet, Gluten-Free; Female; Gastroenterology; Gluten; Gluten-free diet; Hepatology; Heterogeneity; Humans; Internal medicine; Intestine; Male; Materials recovery; Mathematical analysis; Medical diagnosis; Medicine; Medicine and Health Sciences; Meta-analysis; Middle Aged; Mortality; Mucosa; Mucous Membrane - pathology; Nutrition research; Patients; Pediatrics; Physical Sciences; Physiological aspects; Regression analysis; Research and Analysis Methods; Risk factors; Small intestine; Statistical analysis; Studies; Hungary
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0187526

Persistent intestinal damage is associated with higher complication rates in celiac disease. We aimed to assess the potential modifiers of mucosal recovery. We screened databases (PubMed, Embase, Cochrane Trials, and Web of Science) for papers on celiac disease. Papers discussing (1) celiac patients (2) follow-up biopsy and (3) mucosal recovery after commencement of a gluten-free diet were included. The primary outcome was to produce a comprehensive analysis of complete mucosal recovery (i.e., Marsh 0 on follow-up). We compared children's recovery ratios to those of adults. Patients following a strict gluten-free dietary regimen were included in a subgroup. Summary point estimates, 95% confidence intervals (CIs), and 95% predictive intervals (PIs) were calculated. Heterogeneity was tested with I2-statistic. The PROSPERO registration number is CRD42016053482. The overall complete mucosal recovery ratio, calculated from 37 observational studies, was 0.36 (CI: 0.28-0.44, PI: -0.12-0.84; I2: 98.4%, p<0.01). Children showed higher complete mucosal recovery ratio than adults (p<0.01): 0.65 (CI: 0.44-0.85, PI: -0.10-1.39; I2: 96.5%, p<0.01) as opposed to 0.24 (CI: 0.15-0.33, PI: -0.19-1.08; I2: 96.3%, p<0.01). In the strict dietary adherence subgroup, complete mucosal recovery ratio was 0.47 (CI: 0.24-0.70, PI: -0.47-1.41; I2: 98.8%, p<0.001). On meta-regression, diagnostic villous atrophy (Marsh 3) ratio (-8.97, p<0.01) and male ratio (+6.04, p<0.01) proved to be a significant determinant of complete mucosal recovery, unlike duration of gluten-free diet (+0.01, p = 0.62). The correlation between complete mucosal recovery ratio and age on diagnosis is of borderline significance (-0.03, p = 0.05). There is considerable heterogeneity across studies concerning complete mucosal recovery ratios achieved by a gluten-free diet in celiac disease. Several celiac patients fail to achieve complete mucosal recovery even if a strict dietary regimen is followed. Younger age on diagnosis, less severe initial histologic damage and male gender predispose for achieving mucosal recovery.