Researchers discovered that people with potential celiac disease have intestines that are working overtime to repair themselves. By looking at tiny samples of intestinal tissue under a microscope, scientists found that cells in the gut are dividing and multiplying much faster than normal. This excessive cell growth appears to be connected to whether someone’s condition will get worse over time. The study suggests this could become a useful test to help doctors decide if patients need to start a gluten-free diet right away or if they can wait and monitor their symptoms.

The Quick Take

  • What they studied: Whether the rate at which intestinal cells divide and die can help predict which people with potential celiac disease will develop the full condition
  • Who participated: 99 adults total: 36 with potential celiac disease (early signs but not full disease), 32 with active celiac disease (confirmed diagnosis), and 31 healthy controls with no celiac disease
  • Key finding: People with potential celiac disease showed significantly higher rates of intestinal cell division compared to healthy people. Importantly, those with the highest cell division rates were more likely to develop full celiac disease with intestinal damage over time.
  • What it means for you: This research suggests doctors may eventually use intestinal cell division rates as a tool to identify which people with potential celiac disease need to start a gluten-free diet immediately. However, this is still early research and not yet ready for routine clinical use.

The Research Details

This was a comparative study where researchers examined tiny tissue samples from the small intestine (duodenum) of three different groups of people. They used special staining techniques to count how many intestinal cells were actively dividing (using a marker called Ki-67) and how many were dying (using a marker called Caspase-3). The researchers then compared these cell activity rates between the three groups and tracked whether people with potential celiac disease developed full celiac disease over time.

The study used appropriate statistical tests to ensure the differences between groups were real and not due to chance. They also performed follow-up analyses to identify which specific groups differed from each other.

Understanding what happens at the cellular level in potential celiac disease is important because doctors currently struggle with deciding whether to recommend a gluten-free diet for people in this gray zone. If cell division rates can predict who will progress to full disease, it would give doctors a concrete biological marker to guide treatment decisions rather than relying only on symptoms.

This study has several strengths: it used objective laboratory measurements (immunohistochemistry) rather than subjective assessments, included appropriate control groups for comparison, and tracked patients over time to see who developed full disease. However, the sample size is relatively small (36 patients with potential celiac disease), which limits how confidently we can apply these findings to larger populations. The study was published in a peer-reviewed journal, which means other experts reviewed the work before publication.

What the Results Show

The main finding was that people with potential celiac disease had significantly higher rates of intestinal cell division compared to healthy controls (p = 0.042, meaning there’s only about a 4% chance this difference occurred by random chance). Interestingly, the rate at which cells died was similar between groups, suggesting the problem is specifically with excessive cell growth rather than cell death.

The most clinically important finding was a strong correlation between high cell division rates and the development of villous atrophy (the intestinal damage that defines full celiac disease). This means that among the people with potential celiac disease, those whose intestinal cells were dividing fastest were most likely to progress to full disease.

Of the 36 people with potential celiac disease, 31 (86%) reported symptoms like digestive problems or fatigue. Over the follow-up period, 4 people (11%) developed active celiac disease with intestinal damage. The researchers found that those 4 people tended to have higher cell division rates at the start of the study.

The study found that the intestinal lining in potential celiac disease maintains its normal appearance because of the excessive cell division—the body is essentially working overtime to replace damaged cells. However, this rapid turnover means many immature, poorly functioning cells are present on the intestinal surface, which may explain why people have symptoms even though their intestines don’t look obviously damaged under standard examination.

This research builds on existing knowledge that potential celiac disease is a real condition with biological changes, not just a psychological problem. Previous studies showed that some people with potential celiac disease eventually develop full celiac disease, but doctors couldn’t predict who would progress. This study provides a potential biological mechanism (excessive cell turnover) and a measurable marker (Ki-67 expression) that could improve prediction.

The main limitation is the small sample size, particularly the 36 people with potential celiac disease, which limits how confidently these findings apply to larger populations. The study is also relatively short-term, so we don’t know if cell division rates remain predictive over many years. Additionally, the study was conducted at a single center, so results may not apply to all populations. Finally, this research identifies a correlation between cell division and disease progression, but doesn’t prove that excessive cell division causes the progression.

The Bottom Line

Based on this research alone, doctors should not yet use intestinal cell division rates to make treatment decisions for potential celiac disease. However, this finding is promising and suggests that larger, longer-term studies should be conducted to validate this biomarker. If you have potential celiac disease, continue following your doctor’s current recommendations, which typically involve monitoring symptoms and repeating testing periodically.

This research is most relevant to people with potential celiac disease who are uncertain whether to start a gluten-free diet, and to gastroenterologists who care for these patients. It may also interest people with celiac disease in their family who want to understand the disease better. This research is not directly applicable to people with confirmed celiac disease, who should already be following a gluten-free diet.

This is basic research that identifies a potential biomarker. It will likely take 3-5 years of additional validation studies before this test could potentially be used in clinical practice. Don’t expect changes to your doctor’s approach in the near future based on this single study.

Want to Apply This Research?

  • If you have potential celiac disease, track your gastrointestinal symptoms daily (bloating, abdominal pain, diarrhea, constipation) on a scale of 0-10, along with any dietary changes or stress factors. This symptom tracking will help your doctor monitor your condition while waiting for potential new biomarker tests to become available.
  • Work with your doctor to establish a monitoring plan that includes periodic symptom check-ins and repeat testing as recommended. Use the app to maintain a symptom diary and note any changes that might indicate progression to full celiac disease, such as worsening digestive symptoms or new symptoms like fatigue or joint pain.
  • Set up monthly reviews of your symptom patterns within the app to identify trends. Share these reports with your gastroenterologist at regular follow-up appointments to help guide decisions about whether to start a gluten-free diet or continue monitoring. This data will be valuable if your doctor eventually has access to the new biomarker test described in this research.

This research describes a promising laboratory finding but does not yet provide clinical guidance for patient care. If you have potential celiac disease or symptoms suggestive of celiac disease, consult with a gastroenterologist or your primary care physician for personalized medical advice. Do not make dietary changes based on this research alone. This article is for educational purposes and should not be considered medical advice. Always discuss new research findings with your healthcare provider before making any changes to your diet or treatment plan.