Coeliac disease in the modern era: Severity of small bowel mucosal injury at diagnosis with analysis of clinical correlates and rate of improvement on a gluten free diet

Table 1 Comparison of 99 patients with coeliac disease n (%)

	n (%)
Age, yr	43 (30-53)
Male gender	32 (32)
Family history	24 (24)
Main symptom at presentation
Abdominal pain	5 (5)
Bloating	6 (6)
Bone disease	6 (6)
Diarrhoea	31 (31)
Fatigue	6 (6)
Iron deficiency	21 (21)
Incidental1	6 (6)
Screening	14 (14)
Other2	4 (4)

¹Gastroscopy performed to investigate dyspepsia;

²Vitamin B12 deficiency (n = 3), hypoalbuminaemia (n = 1). Continuous variables are presented as median (inter-quartile range).

Table 2 Comparison of duration of 48 patients with symptoms at diagnosis

Duration of symptoms prior to diagnosis	n (%)
< 1 yr	14 (29)
1-3 h	12 (25)
> 3 yr	22 (46)

Table 3 Comparison of 17 patients with an associated autoimmune condition at diagnosis

Thyroid pathology
Graves’ disease	4
Autoimmune thyroiditis	1
Hypothyroidism1	5
Type 1 diabetes	5
Rheumatoid arthritis	1
Pernicious anaemia	1

¹Includes 1 patient with Hashimoto’s thyroiditis.

Table 4 Symptoms, serology and histology results for 99 patients divided by severity of duodenal histology at initial biopsy

Biopsy score1	n (%)	Positive serology2	Symptoms at diagnosis (%)
0	0 (0)	-	-
1	7 (7)	Positive = 7 (100)	0 (0)
		Negative = 0 (0)
		Unknown = 0 (0)
2	2 (2)	Positive = 2 (100)	2 (100)
		Negative = 0 (0)
		Unknown = 0 (0)
3a	29 (29)	Positive = 25 (86)	14 (48)
		Negative = 4 (14)
		Unknown = 0 (0)
3b	12 (12)	Positive = 10 (83)	7 (58)
		Negative = 1 (8)
		Unknown = 1 (8)
3c	49 (49)	Positive = 44 (90)	25 (51)
		Negative = 2 (4)
		Unknown = 3 (6)

¹Marsh-Oberhuber score at diagnosis;

²tissue Transglutaminase antibodies or endomysial antibodies.

Table 5 Presenting symptom of Marsh-Oberhuber score 3c compared to Marsh-Oberhuber score 3a/b n (%)

Presentation	Marsh-Oberhuber score 3a/b1	Marsh-Oberhuber score 3c2	Odds ratio	95%CI	P value
Diarrhoea	13 (32)	18 (37)	1.39	0.33-5.79	0.66
Iron deficiency	8 (20)	11 (22)	1.38	0.30-6.40	0.69
Bone disease	2 (5)	4 (8)	2.00	0.24-16.36	0.52
Bloating	4 (10)	2 (4)	0.50	0.06-4.09	0.52
Fatigue	1 (2)	3 (6)	3.00	0.23-39.60	0.40
Abdominal pain	3 (7)	2 (4)	0.67	0.76-5.88	0.72
Incidental	2 (5)	3 (6)	1.50	0.17-13.23	0.72
Screening	5 (12)	5 (10)	0.33	0.25-4.40	0.40
Other	3 (7)	1 (2)	1.38		0.89

¹n = 41;

²n = 49. CI: Confidence interval.

Table 6 Symptoms, serology and histology results for 87 patients with repeat biopsy

Biopsy score1	Repeat biopsy score	Positive serology2	Reported gluten free diet adherence	Symptoms at repeat biopsy
0	31 (36)	Positive = 6	Yes = 31	Yes = 4
		Negative = 19	No = 0	No = 14
		Unknown = 6		Unknown = 13
1	17 (20)	Positive = 4	Yes = 16	Yes = 2
		Negative = 9	No = 1	No = 10
		Unknown = 4		Unknown = 5
2	5 (6)	Positive = 1	Yes = 5	Yes = 1
		Negative = 4	No = 0	No = 2
		Unknown = 0		Unknown = 2
3a	26 (30)	Positive = 4	Yes = 20	Yes = 3
		Negative = 17	No = 6	No = 12
		Unknown = 5		Unknown = 11
3b	1 (1)	Positive = 0	Yes = 1	Yes = 0
		Negative = 0	No = 0	No = 0
		Unknown = 1		Unknown = 1
3c	7 (8)	Positive = 4	Yes = 3	Yes = 1
		Negative = 1	No = 4	No = 4
		Unknown = 2		Unknown = 2

¹Marsh-Oberhuber score at diagnosis;

²Anti-transglutaminase antibodies or endomysial antibodies.

Table 7 Independent predictors of a Marsh-Oberhuber score ≥ 3a at diagnosis of coeliac disease for 99 patients

Characteristic	Odds ratio	95%CI	P value
Age below 40 yr	0.38	0.08-1.85	0.231
Female gender	3.20	0.35-29.10	0.301
Positive serology	2.06	0.17-25.52	0.573
Symptoms for over 3 yr	0.70	0.04-11.37	0.804
Symptoms at diagnosis	4.54	0.51-40.60	0.176

CI: Confidence interval.

Table 8 Independent predictors of a Marsh-Oberhuber score ≥ 3a after repeat duodenal biopsy, at least 6 mo after diagnosis of coeliac disease for 87 patients

Characteristic	Odds ratio	95%CI	P value
Age below 40 yr	0.59	0.23-1.57	0.292
Female gender	1.13	0.40-3.20	0.824
Gluten free diet	0.03	0.00-0.34	0.004
Symptoms at second biopsy1	0.45	0.81-2.48	0.358
Positive serology at second biopsy	0.64	0.18-2.27	0.485

¹n = 51 patients. CI: Confidence interval.

Table 9 Independent predictors of a Marsh-Oberhuber score < 3 on repeat duodenal biopsy, at least 6 mo after diagnosis of coeliac disease for 87 patients

Characteristic	Odds ratio	95%CI	P value
Age below 40 yr	1.16	0.63-4.31	0.313
Female gender	0.90	0.32-2.52	0.834
Negative serology at time of repeat biopsy	0.72	0.26-1.99	0.524
Asymptomatic at repeat biopsy	1.07	0.41-2.80	0.899
Gluten-free diet	23.57	2.61-212.99	0.005

CI: Confidence interval.