title: Assessment of the response to gluten-free diet in an Iraqi population with coeliac disease. A histological and serological follow-up study.
abstract: BACKGROUND
  Coeliac disease (CD) is a common diagnosis among children and adults in Iraq; however, removal of gluten from the diet is essential for patients with CD. The aim of this study, the first such study in Iraq, was to assess the serological and histological recovery profiles of coeliac patients, in both children and adults groups after commencing a gluten-free diet (GFD) for at least 1 year ± 1 month.
  
  
  METHODS
  The study group comprised 78 proved coeliac patients (46 children and 32 adults, median age: 15 years, range: 1-66 years) who all agreed to undergo endoscopy in addition to serological assessment before and after treatment. The duodenal biopsies were interpreted histologically according to modified Marsh criteria and the sera were tested for anti-gliadin antibody (AGA), endomysium antibody (EMA) and anti-tissue transglutaminase antibody (tTG).
  
  
  RESULTS
  Complete histological remission was seen in 29 (63.1%) of 46 treated children CD patients, while only 5 (10.9%) showed Marsh IIIa changes compared with 11 (24%) before GFD. Similarly none of the 32 adults after GFD showed Marsh IIIb and Marsh IIIc compared with 46.9% and 28.1% before treatment respectively (p = 001). Meanwhile, there was strongly significant reduction in AGA, EMA, and tTG antibodies levels (p = 0.00001) following GFD.
  
  
  CONCLUSIONS
  Repeating the duodenal biopsy 1 year ±1 month after diagnosis and starting a GFD supports the routine measurement of using histological findings as a gold standard test to confirm recovery of Iraqi CD patients along with using known coeliac serology antibodies.
authors.affiliation: Department of Pathology, Faculty of Medicine and Defence Health, University Pertahanan Malaysia (UPNM), Kuala Lumpur, Malaysia.
authors.forename: Muhamed
authors.initials: M
authors.lastname: Osman
authors.affiliation: Specialized Surgeries Hospital, Medical City, Baghdad, Iraq.
authors.forename: Balsam
authors.initials: B
authors.lastname: Taha
authors.affiliation: Clinical Immunologist, Department of Basic Sciences, College of Dentistry, University of Baghdad, Baghdad, Iraq.
authors.forename: Ghada
authors.initials: G
authors.lastname: Al Duboni
keywords: anti-gliadin antibodies; anti-tissue-transglutaminase antibodies; coeliac disease; endomysial antibody; gluten-free diet