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Long-term Histological Follow-up of People with Celiac Disease


QJM celiac study

Celiac.com 07/28/2010 - Most people with celiac disease keep themselves healthy by following a gluten free diet. More and more, doctors are recognizing the importance of confirming gut recovery through follow-up evaluation. Still, among clinicians, there is currently no standard for follow-up confirmation of gut healing in celiac disease treatment.

Many guidelines recommend an initial follow-up biopsy at 4-6 months after the patient begins a gluten-free diet. However, the use of biopsy to confirm gut healing is still controversial, as it can yield enormously variable results.

A group of researchers recently set out to establish the amount of time it takes for full gut recovery in patients with celiac disease.

The research team was made up of J.M. Hutchinson, N.P. West, G.G. Robins and P.D. Howdle. They are variously affiliated with the Sections of Medicine, Surgery and Anesthesia, the Section of Pathology & Tumour Biology at the Leeds Institute of Molecular Medicine in Leeds, and with the Department of Gastroenterology of the York Foundation Hospitals Trust, York, UK.

The team enrolled patients who attended a specialty celiac disease clinic prior to March 2009, and recorded various clinicopathological information into a database.

The team reviewed histopathology reports for all duodenal biopsies, and scored each biopsy for histopathology based on a modified Marsh grade.

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The team indexed and performed at least one biopsy on two hundred and eighty-four patients.

The team found marked gut improvement in two-hundred and twenty-seven patients (80%), and a complete return to normal histology in 100 patients (35%). Average recovery time was 1.9 years, with a range of 1.0–4.8 years.

Patients with less serious celiac disease at the start showed a better overall response (r = 0.281, P < 0.0001), while older patients recovered more quickly (r = –0.200, P = 0.001).

Patients who best followed a gluten-free diet showed the best biopsy scores (r = –0.134, P = 0.040) and the greatest degree of histological recovery (r = 0.161, P = 0.014).

Current guidelines for treatment of celiac disease recommend timing repeat biopsy 4-6 months after commencing a gluten free diet.

These results shows histological recovery generally takes longer than traditionally thought, and that doctors looking to conduct such follow-ups might do well to factor in the patient’s age at diagnosis, the initial disease score, as well as the level of compliance with a gluten free diet.

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4 Responses:

 
Ian geary
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said this on
03 Aug 2010 1:44:32 PM PST
This is rather superficial when dealing with such a complex subject. In the UK there is little opportunity to get endoscopy by request at 4- 6 months. Nor would anyone want one!
There is follow up but it is more 'general'- from my experience.

 
RD Schrock Jr MD
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said this on
03 Aug 2010 2:23:11 PM PST
If I had been asked to undergo a follow-up biopsy, I would have declined respectfully, because I felt so much better on a gluten-free diet and had no doubt about intestinal recovery on that basis. I was no longer lactose intolerant and I was gaining weight. At age 61 the risk of repeat endoscopy outweighed the benefit. My enzymes were repeated and returned to normal.

 
Sarah
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said this on
04 Aug 2010 7:17:00 PM PST
I think this article is great. People are so scared of biopsies, when they are fairly routine, safe, and painless (if you choose to be sedated). for the vast majority of adult patients. I've had 2 without any sedation at all, only anesthetic spray at the back of the throat to reduce the gag reflex. Over in 4 minutes or less, no recovery time with no sedation. Walked out of the day surgery room feeling fine. It's important to have a follow up biopsy as it seems like a strict gluten-free diet alone does not "reverse" Celiac in all Celiacs, especially those like me with "serious" disease. These people may also need steroids, immune modulating drugs, and IV nutrition. You can have normal bloodwork and still have significant intestinal damage. Some complications (I.e. osteoporosis) may not show up until much later, even if you're not as sick or symptomatic.

 
trina
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said this on
22 Aug 2010 2:53:13 PM PST
Good general feedback which may seem overwhelming to see 4.8 yr but to know 'celiacs' is good.




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