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Scientific study: mucosal recovery and mortality in adults with celiac disease after treatment with a gluten-free diet

June 2010 | 5 min read


A clinical response with lessening symptoms is usually seen after treatment with a gluten-free diet in adults with celiac disease. However, the effects of the gluten-free diet on the recovery of the lining of the intestines (mucosa) are not well characterized. This study was designed to estimate the rate of mucosal recovery following institution of a gluten-free diet in a group of adults with celiac disease. Additionally, the study sought to assess the effect of mucosal damage that did not improve after a gluten-free diet.

Key Points

  • The study included 241 patients who had intestinal biopsies at diagnosis and after initiating a gluten-free diet.
  • Results indicated mucosal recovery occurred in 34% of patients after two years and in 66% after five years on a gluten-free diet.
  • While most patients (82%) experienced improvement in symptoms on the diet, symptom improvement did not predict mucosal recovery.
  • Factors associated with lack of improvement of mucosal damage included poor adherence to the gluten-free diet; severe symptoms of celiac disease, including diarrhea and weight loss; and severe mucosal damage at diagnosis. There was strong trend toward reduced mortality in patients who experienced mucosal recovery on the gluten-free diet.
  • The authors concluded, “Mucosal recovery was absent in a substantial portion of adults with celiac disease after treatment with a gluten-free diet. There was a borderline significant association between confirmed mucosal recovery (vs. persistent damage) and reduced mortality independent of age and gender.”

Key Takeaways

Follow-up with intestinal biopsies may be advisable in patients diagnosed with celiac disease as adults. Patients who adhere to the gluten-free diet have a greater chance of healing their intestinal lining in addition to improved symptoms.


Rubio-Tapia A, et al. Mucosal Recovery and Mortality in Adults with Celiac Disease after Treatment with a Gluten-Free Diet. Am J Gastroenterol 2010; 105(6):1412–1420. doi:10.1038/ajg.2010.10