Villous atrophy persistence in celiac disease despite following a gluten-free diet must be clarified.

We read with great interest the article recently published in REED by Shadegi et al. Villous atrophy (VA) persists in 35 % and 23.7 % of celiac disease (CD) patients for six and 24 months, respectively, after following a gluten-free diet (GFD). The authors think that the time following a GFD must be longer than two years in some patients to achieve mucosal healing and we agree with this. Our experience comes from a short series of ten females and three males with CD, diagnosed at an average age of 36 years (15-72) based on serology (anti-TG2 > 10 IU/ml or anti-Em positive) and a duodenal biopsy showing VA. All cases followed a GFD, according to the anamnesis and underwent a second duodenal biopsy and anti-TG2 determination after 42 (10-202) months. Immunogenic peptides of gluten (IPG) in feces were determined in four patients.