title: Optimising delivery of care in coeliac disease - comparison of the benefits of repeat biopsy and serological follow-up.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To inform the clinical management of CD using comparative serological and histological data from a biopsy-driven pathway of care.
  
  
  METHODS
  A retrospective analysis of the Cambridge Coeliac Clinic database of 595 patients routinely followed up by biopsy and serology.
  
  
  RESULTS
  Paired biopsy results were available for 391 patients (15% seronegative). Persisting villous atrophy (VA) occurred in 182 patients (47%). The sensitivity of anti-tissue transglutaminase (TTG) antibody for ongoing VA was only 43.6%. 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 analysed in 298 patients. Discharge to primary care and clinical management was facilitated by the information derived from repeat biopsy.
  
  
  CONCLUSIONS
  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 coeliac disease suitable for early discharge from secondary care or those requiring more intensive clinical management.
authors.affiliation: Department of Gastroenterology and Clinical Nutrition, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: L M
authors.initials: LM
authors.lastname: Sharkey
authors.forename: G
authors.initials: G
authors.lastname: Corbett
authors.forename: E
authors.initials: E
authors.lastname: Currie
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.forename: N
authors.initials: N
authors.lastname: Sweeney
authors.forename: J M
authors.initials: JM
authors.lastname: Woodward
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000276:immunology; D001284:Atrophy; D001706:Biopsy / Q000379:methods; D002446:Celiac Disease / Q000178:diet therapy / Q000473:pathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000379:methods*; D055050:Diet, Gluten-Free; D005260:Female; D005500:Follow-Up Studies; D019204:GTP-Binding Proteins / Q000276:immunology; D005983:Glutens / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D011503:Transglutaminases / Q000276:immunology; D055815:Young Adult
chemical_list: D000906:Antibodies; D005983:Glutens; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins