Gluten-free diet without villous atrophy
Celiac disease is diagnosed when villous atrophy (Marsh III intestinal lession) is observed in small bowel biopsies. The only successful treatment is a strict long-life gluten-free diet, which allows the recovery of the gut mucosa and lead to the reduction of CD-specific antibody levels and the dissapearance of symptoms. Patients suffering from mild enteropathy (that is, Marsh I-II intestinal lessions) are not usually considered as having celiac disease. However, the experience shows how some of such patients improve after following a gluten-free diet.
The question is clear: Should people with mild enteropathy be diagnosed as having celiac disease and follow a gluten-free diet?
Kurppa et al (2009) recommend a gluten-free diet when a mild enteropathy occur together with positive anti-endomysial antibody levels. They found how patients showing Marsh I-II histological lessions had a reduction in gut inflammation and a decrease in serum antibody levels after a year under a gluten-free diet; they also experienced symptoms alleviation. By contrast, the severity of the intestinal lessions increased in those patients who continued consuming gluten-contaning foods, who didn´t have any change in the symptoms or serum antibody levels.
Vande Voort et al (2009), however, conclude that only a small proportion of people suffering from lymphocytic duodenosis (Marsh I-II intestinal lession) belong to the spectrum of celiac disease, that is, are sensitive to gluten. They found that most of the patients analysed with lymphocytic duodenosis differ significantly from those with celiac disease regarding genetics (HLA), antibody levels and associated conditions.
References:
Kurppa K, Collin P, Viljamaa M, Haimila K, Saavalainen P, Partanen J, Laurila K, Huhtala H, Paasikivi K, Maki M, Kaukinen K (2009) Diagnosing mild enteropathy celiac disease: a randomized, controlled clinical study. Gastroenterology 136: 816-823.
http://www.gastrojournal.org/article/S0016-5085(08)02070-2/abstract
Vande Voort JL, Murray JA, Lahr BD, Van Dyke CT, Kroning CM, Moore SB, Wu T (2009) Lymphocytic duodenosis and the spectrum of celiac disease. The American Journal of Gastroenterology 104: 142-148.
http://www.nature.com/ajg/journal/v104/n1/abs/ajg200835a.html