Long-term histological follow-up of people with coeliac disease in a UK teaching hospital.
BACKGROUND
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.


OBJECTIVE
To determine the length of time to histopathological recovery in a group of coeliac disease patients and its associations with clinicopathological data.


METHODS
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.


RESULTS
Two hundred and eighty-four patients underwent index and at least one subsequent biopsy. Two-hundred and twenty-seven (80%) showed histopathological improvement and 100 (35%) returned to normal (median recovery time 1.9 years, inter-quartile range 1.0-4.8 years). Patients with less severe disease at diagnosis were more likely to show a better response (r = 0.281, P < 0.0001). Older patients demonstrated a shorter time to histopathological recovery (r = -0.200, P = 0.001). Compliance with a gluten free diet was correlated with the best biopsy score (r = -0.134, P = 0.040) and degree of histological recovery (r = 0.161, P = 0.014).


CONCLUSIONS
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.
Section of Medicine, Surgery and Anesthesia, Leeds Institute of Molecular Medicine, Leeds, UK.
J M
JM
Hutchinson
N P
NP
West
G G
GG
Robins
P D
PD
Howdle
D000328:Adult; D001706:Biopsy; D002446:Celiac Disease / Q000178:diet therapy / Q000473:pathology*; D055050:Diet, Gluten-Free; D018572:Disease-Free Survival; D004386:Duodenum / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D013997:Time Factors; D006113:United Kingdom