Histological Recovery Profiles Of Patients With Celiac Disease- An Indian Perspective.
Dr Rahul Mannan,C/O Dr V. K Rampal,5-Court Road, Amritsar-143001,Punjab(India)Ph- +91946354525 (O), 091-0183-2504062 (R)
Celiac disease is characterized by malabsorption, abnormal small bowel structure and intolerance to gluten. The present study was planned to determine the histological recovery profiles of patients with celiac disease especially, north Indians who consume wheat as the staple diet.
56 patients were selected for the present study, who were diagnosed to have celiac disease on the basis of their clinical profiles (according to the criteria enumerated by the European society for pediatrics gastroenterology and nutrition), serological examination and confirmation on endoscopic biopsy. Repeat biopsies were taken in all 56 cases. Marsh classification was employed to score the biopsies.
The most common histological presentation at the first biopsy was total villous atrophy (Marsh stage IIIc, 83.9%) followed by subtotal villous atrophy (Marsh stage IIIb, 12.5%) and partial villous atrophy (Marsh stage IIIa, 3.6%). At the end of minimum one year of gluten free diet it was observed that 42 cases (75%) of showed some degree of histological down staging. Of these, 26 (46.42%) recovered completely i.e. to marsh stage 0 (normal villous pattern). Also, 14 out of 56 (25%) cases did not down stage, implying a lack of histological recovery.
The study adds to the limited literature which is available on the histological recovery profiles of patients with celiac disease in the Indian population. The study emphasizes on two facts, one, a time dependency of the response of gluten free diet and second, the importance of proper categorization at the initial biopsy, as higher grades lead to therapeutic refraction.