Details of 12 patients suffering from atrophy of the coeliac mucosa (A
CM) are presented. These patients failed to respond to the elimination
of gluten from their diets. Their jejunal biopsies were examined in d
etail with particular attention given to Paneth cell numbers, crypt le
ngth, mitotic rate and mucosal thickness. These biopsies were compared
with the biopsies of responsive coeliac patients, The ACM patients we
re found to have a statistically significant reduction in Paneth cell
numbers (P < 0.0005), reduced crypt length (P < 0.0125), reduced mitot
ic rate (P < 0.0005) and a thinner mucosa (P < 0.0005), when compared
with the responsive coeliac group. In addition the ACM group had a low
er albumin level compared with the responsive group (P < 0.0005), Most
of the ACM patients responded when treated with oral corticosteroids.
It is considered that the above features are markers of a non-respons
ive group of coeliac patients and thus might be useful for identifying
those patients who may benefit from early treatment with oral cortico
steroids if gluten withdrawal is not rapidly effective. Eur J Gastroen
terol Hepatol 10:523-525 (C) 1998 Lippincott-Raven Publishers.