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Optimizing delivery of care in celiac disease

The latest study published in the Alimentary Pharmacology & Therapeutics compares the benefits of repeat biopsy and serological follow-up in celiac disease.

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The 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.

Dr Woodward and colleagues from the United Kingdom informed the clinical management of CD using comparative serological and histological data from a biopsy-driven pathway of care.

A retrospective analysis of the Cambridge Coeliac Clinic database of 595 patients routinely followed up by biopsy and serology.

Paired biopsy results were available for 391 patients.

Persisting villous atrophy occurred in 47%
Alimentary Pharmacology & Therapeutics

Persisting villous atrophy (VA) occurred in 47% of patients.

The team found that the sensitivity of anti-tissue transglutaminase (TTG) antibody for ongoing VA was only 44%.

Information on dietetic management and further biopsy to assess response was available for 94 initially unresponsive patients, in whom targeted dietetic intervention by removal of identified gluten sources or avoidance of trace amounts of gluten led to resolution of persistent VA in 50%.

The effects of institution of a formal care pathway are analyzed in 298 patients.

The research team found that discharge to primary care and clinical management was facilitated by the information derived from repeat biopsy.

Dr Woodward's team concludes, "Serology appears to be a poor surrogate marker for mucosal recovery on a gluten-free diet; dietary assessment fails to identify a potential gluten source in many patients with ongoing villous atrophy."

"The benefits of re-biopsy on diet include stratification of patients with celiac disease suitable for early discharge from secondary care or those requiring more intensive clinical management."

Aliment Pharmacol Ther 2013: 38(10): 1278-1291
05 November 2013

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