Duodenal mucosa in children with coeliac disease in catamnesis and varying compliance with the gluten-free diet.

OBJECTIVES

the aim of the study was to identify the characteristic morphometric data changes in the small intestine mucosa in response to varied compliance with gluten-free diet in children with coeliac disease.

METHODS

71 children (47 girls and 24 boys) aged 2.5 to 16.5 (median age=10.6) with coeliac disease diagnosed according to the previously revised ESPGHAN criteria were included in the study. The patients were divided into three groups: 1 - on strict GFD, 2 - on semistrict GFD, 3 - not on GFD. Quantitative morphometric data on biopsies of duodenal mucosa in each group were compared with each other.

RESULTS

As compared with group 1, patients from group 2 had a lower villous height (Vh)/crypt depth (Cd) ratio, but a higher Cd, total cell density of lamina propria, plasma cells density in the villi and fibroblasts density in the space between the crypts. In patients from group 3, as compared with group 1, we found a significant reduction in Vh and Vh/Cd ratio, and a significant decrease in the number of goblet cells. At the same time they yielded an increase in Cd, number of intraepithelial lymphocytes (IEL), total cell density and plasma cells density throughout the lamina propria depth, number of macrophages and neutrophils in the villous lamina propria, and number of fibroblasts in the space between crypts. The differences were statistically significant.

CONCLUSION

Quantitative morphometric parameters of small intestine mucosa allow revealing statistically significant differences between the groups of children with coeliac disease in response to varied compliance with GFD. This enables us to assess the dynamics of the pathological process and enhance our understanding of its nature, which is very important for improving the therapy and prognosis (Ref. 40).