Optimising delivery of care in coeliac disease – comparison of the benefits of repeat biopsy and serological follow‐up

Abstract

SUMMARY BackgroundThe majority of deleterious health consequences of coeliac disease (CD) are most likely to be secondary to intestinal inflammation; hence, mucosal recovery is a desirable goal of therapy. Follow-up in CD is controversial and serological response is often used as a surrogate for histological recovery.

The Role of an IgA/IgG-Deamidated Gliadin Peptide Point-of-Care Test in Predicting Persistent Villous Atrophy in Patients With Celiac Disease on a Gluten-Free Diet

“…Histological remission is not always achieved in adults, with remission rates ranging from 34%-65%. (9)(10)(11) This is an important point because persistent villous atrophy increases the risk of lymphoproliferative malignancies (HR 2.26) (12) and hip fractures (HR 1.67). (13) Consequently, the logical approach for disease monitoring would be histological assessment of the duodenum for mucosal healing.…”

Letter: follow‐up practices in coeliac disease – intestinal biopsy after child‐to‐adult transition might be useful; authors' reply

“…1,2 We are particularly glad that they highlighted the 15% of our patients who were seronegative for tissue transglutaminase (TTG) antibodies. Studies frequently cited as demonstrating the performance of the TTG antibody test are often methodologically poor and open to bias that artificially inflates the sensitivity.…”

Commentary: refractory coeliac disease – rigorous management revealing, or resulting in, rarity? Authors' reply

“…2 Symptom relief may thus not prevent later complications, 3 nor does the normalisation of serology: subtotal villous atrophy may even be present in patients with negative anti-tissue transglutaminase antibodies. On the other hand, positive serology does not necessarily mean dietary transgressions, albeit this being the most common explanation.…”

“…On the other hand, positive serology does not necessarily mean dietary transgressions, albeit this being the most common explanation. 3 Given the high specificity of serology, coeliac disease is often evident even before verification through biopsy.…”

“…1,2 Furthermore, the published literature suggests that the presence of persistent villous atrophy is common, from 27% to 47%. 3 Thus, the prospect of a non-invasive marker could be beneficial to patients. The potential identification of deamidated gliadin peptide antibodies (IgG-dGP) as a marker of histological remission is an ª 2014 John Wiley & Sons Ltd…”