<<Disclaimer: Verify this information before applying it to your situation.>>

Return of villi to normal after GF diet is a process that may take a
variable amount of time. However, I believe 2 years has just never been
reported!  Actually, in the original ESPGAN protocol for diagnosis of CD,
the lack of return to normal after 1 year of GFD was taken as a convincing
proof that the cause of flat mucosa can not be CD.

Possibilities are:

1) You are actually still eating gluten in some hidden form (Holy Communion?
Other?)  Normal blood work-up however (IF including anti-endomysium
antibodies!) speaks against it.

2) Histology was not performed accurately. Sometimes it may happen that the
specimen is improperly orientated or tangentially cut, leading to the false
interpretation of a still flat mucosa. Believe me, it takes a very
experienced pathologist to realize that the specimen may not be perfectly
handled for interpretation.

3) You have another disease leading to flat mucosa. This is obviously a real
possibility, although full clinical and laboratory remission (which I simply
assume) after GFD are an indirect but sound evidence for CD. Other causes of
flat mucosa include Crohn's, food allergy (but particularly in the first 2
years of life!), small bowel bacterial overgrowth, infection by Giardia
Lamblia. Ask your doctor about these entities.

As for Helicobacter pylori infection, this microrganism is known to be able
to colonize only gastric mucosa, and is not a known cause for inflammation
of duodenal-jejunal mucosa leading to shortening of villi.

Hope to have been of some help!

Stefano Guandalini