Trace gluten contamination may play a role in mucosal and clinical recovery in a subgroup of diet-adherent non-responsive celiac disease patients

Table 3 Effect of Gluten Contamination Elimination Diet on celiac serology, main clinical symptoms and histologic findings

Patient	Serology before¹	Serology after¹	Symptoms before	Symptoms after	Biopsy before	Biopsy after
1	High	Neg	Abdominal pain	None
2	High	Neg	Inadequate weight gain	None
3	High	Neg	Diarrhea, fatigue	None	Marsh 3a (RCD)	Refused
4	High	Neg	Constipation	None	Marsh 3 (RCD)
5	High	Weak Pos	None	None	Marsh 3a	Marsh 1
6	High	Weak Pos	Elevated transaminases	None	Marsh 2
7	High	Weak Pos	Constipation, fatigue	None		Marsh 1
8	High	Weak Pos	Diarrhea	None	Marsh 1
9	High	High	Diarrhea, abdominal pain, bloating	None	Marsh 3a (RCD)	Marsh 1
10	High	High	Fatigue, anxiety	Fatigue, anxiety		Marsh 3a (RCD1)
11	Weak Pos	Neg	Diarrhea, abdominal pain	None	Marsh 2	Marsh 0
12	Weak Pos	Neg	Diarrhea	None	Marsh 1
13	Weak Pos	Weak Pos	Inadequate weight gain	Inadequate weight gain
14	Neg	Neg	Diarrhea, bloating, fatigue	None	Marsh 0
15	Neg	Neg	Abdominal pain, fatigue	None	Marsh 3a (RCD), VCE: Atrophy	VCE : normal
16	Neg	Neg	Diarrhea, weight loss	None	Marsh 3b (RCD)	Lost to follow-up
17	Neg	Neg	Diarrhea, abdominal pain, bloating	Diarrhea, abdominal pain, bloating	Marsh 3a (RCD)	VCE : atrophy

¹ Celiac serology defined as negative, weak positive or high using the cut-offs provided by the ELISA kit manufacturer. Tissue transglutaminase (tTG) IgA was followed in 16/17 patients; anti-endomysial (EMA) IgA was followed in the remaining patient.
Pos, positive; RCD, refractory celiac disease; RCD1, refractory celiac disease type 1; VCE, video capsule endoscopy.