For many years diarrhea, weight loss and bloating have been considered the classic symptoms of celiac disease. However, it is now known that the mode of manifestation of celiac disease is highly variable. Some patients have no symptoms after ingesting gluten, although intestinal damage always occurs.

At the last international conference on celiac disease, ICDS 2022, the group led by Nemteanu et al. presented a study showing that the apparent disappearance of satisfactory clinical response is not always indicative of recovery of the intestinal mucosa.

In the study presented, 102 celiac patients participated who underwent two biopsies: one for diagnosis and another for follow-up. In addition, their clinical response (symptoms and serology) after removing gluten from the diet is evaluated.

Initial biopsy results

👉77.5% presented at Marsh III.

👉22.5% presented at Marsh I-II

Follow-up biopsy results (after gluten withdrawal):

👉61.7% had recovery of the intestinal mucosa.

👉59.8% of patients have persistent vellous atrophy.

Symptoms after eliminating gluten from the diet:

👉88.2% presented a satisfactory clinical response.

👉Only 11.8% presented a partial improvement.


In this study, the satisfactory clinical response (symptoms and celiac-specific serology) correlate poorly with the recovery of the intestinal mucosa. This can cause “recovered” patients to be misidentified and may be at increased risk of long-term complications.


Reference: Nemteanu et al. Clinical and histological recovery of patients with celiac disease. Poster presented at: ICDS 2022. 19th International Celiac Disease Symposium; 2022 October 19-22; Sorrento, Italy.