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This abstract reveals that intestinal damage persists in most CD patients
even years after maintaining a GF diet.  One wonders if "leaky gut" and
food allergies persist, as well, as a result of this continued intestine
damage.

"Duodenal histology in patients with celiac disease after treatment with a
gluten-free diet
Gastrointest Endosc 2003 Feb;57(2):187-91     (ISSN: 0016-5107)
Lee SK; Lo W; Memeo L; Rotterdam H; Green PH
Current affiliations: Department of Surgical Pathology and Medicine,
Columbia University College of Physicians and Surgeons, New York, New York.
BACKGROUND: The diagnosis of celiac disease requires characteristic
histopathologic changes in an intestinal biopsy with clinical improvement
in response to a gluten-free diet. Endoscopy with procurement of biopsy
specimens is often performed to document response to the diet, but there
are little data on the appearance of treated celiac disease. This study
examined the endoscopic and histopathologic appearance of the duodenum of
patients with celiac disease whose diet was gluten-free. METHODS: A cohort
of 39 adult patients (mean age 52 years, range 20-74 years) with biopsy-
proven celiac disease was retrospectively reviewed. All had responded
clinically to a gluten-free diet that they had maintained for a mean of 8.5
years (range 1-45 years). The endoscopic and histopathologic appearances of
the duodenal mucosa were reviewed. Blinded review of the diagnostic
(initial) and post-treatment biopsy specimens was also performed to assess
response of individual patients to the diet. RESULTS: The endoscopic
appearance was normal in 23%, reduced duodenal folds were present in 46%,
scalloping of folds in 33%, mucosal fissures in 44%, and nodularity in 33%.
There was more than 1 abnormality present in 46%. Histology was normal in
only 21%. The remainder had villous atrophy (69% partial, 10% total).
Paired (diagnostic and follow-up) biopsy specimens were reviewed blindly
for 12 patients. The mean (SD) intraepithelial lymphocyte count fell from
61 (22) to 38 (17) (normal <30 per 100 epithelial cells) and the crypt-to-
villous ratio improved although it did not normalize. CONCLUSIONS: Despite
a good clinical response, abnormal endoscopic and histopathologic
appearances persist in the majority of patients with celiac disease treated
with a gluten-free diet."

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