By Van Waffle
Summary: This study, based on follow-up care at Addenbrooke’s Hospital, Cambridge University, England, explores how to best assess a patient’s recovery from celiac disease. Worldwide, follow-up care after a diagnosis is highly variable. At many clinics, it includes counseling to establish a gluten-free diet, monitoring for improved symptoms and blood tests to determine reduction of celiac disease antibodies. The process often omits a repeated tissue biopsy to see whether the intestinal lining shows signs of repair. The American Gastroenterological Association currently does not recommend this expensive procedure.
But assessing patients’ progress without checking the gut has drawbacks. Intestinal damage likely causes most of the long-term complications associated with celiac disease, some of which can occur without causing any symptoms for years.
The celiac clinic at Cambridge routinely conducted follow-up biopsies after nine to 12 months to determine how well the gut lining had responded to treatment. Both biopsy and blood test results were available for 391 patients in the study. Improved symptoms were not considered as criteria for follow-up testing. Intestinal damage continued despite treatment with the gluten-free diet in 182 of these patients. However, the blood test proved to be a poor predictor, detecting celiac disease antibodies in only 44 percent of these cases where intestinal damage was found. Further intervention by a dietitian to help identify unknown sources of gluten and refine the diet resulted in recovery by half the patients who were initially unresponsive.
Conclusion: Blood tests provide a poor substitute for biopsy in determining whether the gut lining fails to respond to treatment for celiac disease. Biopsy identifies patients who are having trouble complying or are unaware of a source of gluten in their diet. While expensive, it may reduce long-term health problems and costs from where the intestines fail to heal.
 “Optimising delivery of care in coeliac disease – comparison of the benefits of repeat biopsy and serological followup”, Sharkey LM, Corbett G, Currie E, Lee J, Sweeney N, Woodward JM, #Alimentary Pharmacology and Therapeutics#, 2013 Nov; 38(10):1278-91.