Effect of a gluten‐free diet on growth and small‐bowel histology in children with celiac disease in India

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Abstract
Background and Aim: Follow‐up studies on growth and histological recovery of children with celiac disease (CD) while on a gluten‐free diet (GFD) are lacking from Asia. We therefore assessed the effects of this diet. Methods: Forty‐two children with CD were enrolled. Weight and height were expressed as weight for height (WfH) and height standard deviation scores (HSDS), respectively. Twenty‐five children had repeated duodenal biopsies after 1–2 years and 14 had a third biopsy after 3–7 years of GFD. Compliance was checked by regular interview and IgA antiendomysial antibody estimation (EMA). Results: At diagnosis (n = 25), mean HSDS was −3.3 ± 1.6 with 76% having a HSDS of <−2; 60% were undernourished (WfH mean 81.6 ± 5.7). Over a mean follow up of 3.7 years, HSDS improved to −1.3 ± 1.7 and 84% cases achieved normal nutrition. Mean height velocity was 13.9 cm during first year and 5.6 cm in subsequent years. Small‐bowel biopsies at diagnosis showed subtotal villous atrophy (Marsh IIIb) in 18 (72%) and partial villous atrophy (Marsh IIIa) in seven (28%) patients. Repeat biopsy at 1–2 years showed shift from subtotal to partial villous atrophy in 94% (n = 17/18) and normalization in one patient. In patients with Marsh IIIa improvement of partial villous atrophy was observed in all. Immunoglobulin A endomysial antibody was negative in 81%. Repeat biopsies at 5 years of GFD showed improvement to Marsh I–II, but none normalized. Conclusion: The majority of children with CD show normalization of nutrition and growth after GFD. Small‐bowel histology improves markedly but does not normalize even after 5 years of GFD.