Adherence to the gluten-free diet can achieve the therapeutic goals in almost all patients with coeliac disease: A 5-year longitudinal study from diagnosis

Background: Key aims of treatment of coeliac disease are to heal the intestinal mucosa and correct nutritional abnormalities. Aim: We aim to determine prospectively the degree of success and time course of achieving those goals with a gluten-free diet. Methods: Ninety-nine patients were enrolled at diagnosis and taught the diet. The first 52 were reassessed at 1year and 46 at 5years, 25 being assessed at the three time points regarding dietary compliance (dietitian-assessed), coeliac serology, bone mineral density and body composition analysis by dual energy X-ray absorptiometry, and intestinal histology. Results: Mean age (range) was 40 (18-71) years and 48 (76%) were female. Dietary compliance was very good to excellent in all but one. Tissue transglutaminase IgA was persistently elevated in 44% at 1year and 30% at 5years and were poorly predictive of mucosal disease. Rates of mucosal remission (Marsh 0) and response (Marsh 0/1) were 37% and 54%, and 50% and 85% at 1 and 5years, respectively. Fat mass increased significantly over the first year in those with normal/reduced body mass index. Lean body mass indices more slowly improved irrespective of status at diagnosis with significant improvement at 5years. Bone mass increased only in those with osteopenia or osteoporosis, mostly in year 1. Conclusion: Dietary compliance is associated with a high chance of healing the intestinal lesion and correction of specific body compositional abnormalities. The time course differed with body fat improving within 1year, and correction of the mucosal lesion and improvement in lean mass and bone mass taking longer.