Open Access Research article

A multicentre case control study on complicated coeliac disease: two different patterns of natural history, two different prognoses

Federico Biagi12*, Alessandra Marchese12, Francesca Ferretti12, Rachele Ciccocioppo12, Annalisa Schiepatti12, Umberto Volta1, Giacomo Caio1, Carolina Ciacci2, Fabiana Zingone2, Anna D’Odorico3, Antonio Carroccio4, Giuseppe Ambrosiano5, Pasquale Mansueto5, Antonio Gasbarrini6, Anna Chiara Piscaglia6, Alida Andrealli7, Marco Astegiano7, Sergio Segato8, Matteo Neri9, Alberto Meggio10, Giovanni de Pretis10, Italo De Vitis11, Paolo Gobbi12 and Gino Roberto Corazza12

Author Affiliations

1 Coeliac Centre/Department of Clinical Medicine, St Orsola-Malpighi University Hospital, Bologna, Italy

2 Department of Medicine and Surgery, Gastrointestinal Immune Diseases Centre, University of Salerno, Salerno, Italy

3 Department of Surgical and Gastroenterological Sciences, University of Padua, Padua, Italy

4 Ospedali Civili Riuniti di Sciacca, University of Palermo, Palermo, Italy

5 Internal Medicine, University of Palermo, Palermo, Italy

6 Department of Internal Medicine, Catholic University of Sacred Heart, Gemelli University Hospital, Rome, Italy

7 Department of Gastro-Hepatology, AOU San Giovanni Battista Molinette, University of Turin, Turin, Italy

8 Gastroenterology and Endoscopy Unit, Ospedale di Circolo di Varese, Fondazione Macchi, Turin, Italy

9 Department of Internal Medicine, University “G D'Annunzio” of Chieti, Turin, Italy

10 UO Multizonale di Gastroenterologia ed Endoscopia APSS Trento, Rome, Italy

11 Internal Medicine and Gastroenterology Unit, UCSC-CIC, Rome, Italy

12 Coeliac Centre/First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, P.le Golgi, 19, I-27100, Pavia, Italy

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BMC Gastroenterology 2014, 14:139  doi:10.1186/1471-230X-14-139

Published: 7 August 2014



Coeliac disease is a common enteropathy characterized by an increased mortality mainly due to its complications. The natural history of complicated coeliac disease is characterised by two different types of course: patients with a new diagnosis of coeliac disease that do not improve despite a strict gluten-free diet (type A cases) and previously diagnosed coeliac patients that initially improved on a gluten-free diet but then relapsed despite a strict diet (type B cases). Our aim was to study the prognosis and survival of A and B cases.


Clinical and laboratory data from coeliac patients who later developed complications (A and B cases) and sex- and age-matched coeliac patients who normally responded to a gluten-free diet (controls) were collected among 11 Italian centres.


87 cases and 136 controls were enrolled. Complications tended to occur rapidly after the diagnosis of coeliac disease and cumulative survival dropped in the first months after diagnosis of complicated coeliac disease. Thirty-seven cases died (30/59 in group A, 7/28 in group B). Type B cases presented an increased survival rate compared to A cases.


Complicated coeliac disease is an extremely serious condition with a high mortality and a short survival. Survival depends on the type of natural history.

Celiac disease; Complications; EATL; Prognosis; Glutens; Gluten-free diet