Results of subgroup analyses.

<p>Results of subgroup analyses.</p

Characteristics of the included studies.

<p>H: high quality, L: low quality, NR: not reported, P: prospective, R: retrospective.</p

Younger age at diagnosis predisposes to mucosal recovery in celiac disease on a gluten-free diet: A meta-analysis

<div><p>Background and aims</p><p>Persistent intestinal damage is associated with higher complication rates in celiac disease. We aimed to assess the potential modifiers of mucosal recovery.</p><p>Materials and methods</p><p>We screened databases (PubMed, Embase, Cochrane Trials, and Web of Science) for papers on celiac disease. Papers discussing (1) celiac patients (2) follow-up biopsy and (3) mucosal recovery after commencement of a gluten-free diet were included. The primary outcome was to produce a comprehensive analysis of complete mucosal recovery (i.e., Marsh 0 on follow-up). We compared children’s recovery ratios to those of adults. Patients following a strict gluten-free dietary regimen were included in a subgroup. Summary point estimates, 95% confidence intervals (CIs), and 95% predictive intervals (PIs) were calculated. Heterogeneity was tested with I²-statistic. The PROSPERO registration number is CRD42016053482.</p><p>Results</p><p>The overall complete mucosal recovery ratio, calculated from 37 observational studies, was 0.36 (CI: 0.28–0.44, PI: -0.12–0.84; I²: 98.4%, p<0.01). Children showed higher complete mucosal recovery ratio than adults (p<0.01): 0.65 (CI: 0.44–0.85, PI: -0.10–1.39; I²: 96.5%, p<0.01) as opposed to 0.24 (CI: 0.15–0.33, PI: -0.19–1.08; I²: 96.3%, p<0.01). In the strict dietary adherence subgroup, complete mucosal recovery ratio was 0.47 (CI: 0.24–0.70, PI: -0.47–1.41; I²: 98.8%, p<0.001). On meta-regression, diagnostic villous atrophy (Marsh 3) ratio (-8.97, p<0.01) and male ratio (+6.04, p<0.01) proved to be a significant determinant of complete mucosal recovery, unlike duration of gluten-free diet (+0.01, p = 0.62). The correlation between complete mucosal recovery ratio and age on diagnosis is of borderline significance (-0.03, p = 0.05).</p><p>Conclusions</p><p>There is considerable heterogeneity across studies concerning complete mucosal recovery ratios achieved by a gluten-free diet in celiac disease. Several celiac patients fail to achieve complete mucosal recovery even if a strict dietary regimen is followed. Younger age on diagnosis, less severe initial histologic damage and male gender predispose for achieving mucosal recovery.</p></div

Forest plot comparing long term stricture resolution in different subgroups using modified rate with ordinary weighting.

<p>Forest plot comparing long term stricture resolution in different subgroups using modified rate with ordinary weighting.</p

Forest plot: Complete mucosal recovery ratios of each study included.

<p>Forest plot: Complete mucosal recovery ratios of each study included.</p

Forest plot comparing long term stricture resolution in different subgroups using originally published rate with follow-up weighting.

<p>Forest plot comparing long term stricture resolution in different subgroups using originally published rate with follow-up weighting.</p

Forest plot: Complete mucosal recovery ratios of children-to-adults comparison.

<p>Forest plot: Complete mucosal recovery ratios of children-to-adults comparison.</p

Detailed results of meta-regressions.

<p>Detailed results of meta-regressions.</p

PRISMA diagram for the study.

<p>PRISMA diagram for the study.</p

Forest plot: Complete mucosal recovery ratios of patients after 12-month gluten-free diet.

<p>Forest plot: Complete mucosal recovery ratios of patients after 12-month gluten-free diet.</p