For coeliac disease, histological recovery later than traditionally thought

January 01, 0001

For coeliac disease, histological recovery later than traditionally thought

Coeliac disease is a relatively common condition which is usually managed by placing patients on a gluten free diet. Follow up biopsies to confirm histological recovery are controversial with a considerable variation in practice observed. The aim of this study was to determine the length of time to histopathological recovery in a group of coeliac disease patients and its associations with clinicopathological data. All patients attending a specialist coeliac disease clinic prior to March 2009 were entered onto a database which recorded various clinicopathological data. The histopathology reports for all duodenal biopsies were reviewed and each biopsy was given a histopathological disease score based on a modified Marsh grade. Two hundred and eighty-four patients underwent index and at least one subsequent biopsy.

80% showed histopathological improvement and 35% returned to normal (median recovery time 1.9 years). Patients with less severe disease at diagnosis were more likely to show a better response. Older patients demonstrated a shorter time to histopathological recovery. Compliance with a gluten free diet was correlated with the best biopsy score and degree of histological recovery.

The researchers concluded: "Current guidelines for the timing of repeat biopsy after commencing a gluten free diet are unclear, although 4-6 months has been recommended. This study shows that time to histological recovery is longer than traditionally thought and may need to take into account the patient’s age at diagnosis, the initial disease score and the level of compliance with a gluten free diet."

We have a ‘gold standard’ test for diagnosis, but it loses some gloss as a follow-up test, mainly due to timing.

For the full abstract, click here.

QJM 103(7):511-517, July 2010
© 2010 Association of Physicians of Great Britain and Ireland
Long-term histological follow-up of people with coeliac disease in a UK teaching hospital. J.M. Hutchinson, N.P. West, G.G. Robins and P.D. Howdle. Correspondence to Gerry Robins: [email protected]

Category: D. Digestive. Keywords: coeliac disease, histological, follow-up, long-term, cohort study, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 30 July 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.