Performing routine follow-up biopsy 1 year after diagnosis does not affect long-term outcomes in coeliac disease.
A repeat biopsy is recommended, but often omitted in coeliac disease patients on a gluten-free diet. The effect of performing or not performing repeat biopsies is currently unknown.



To identify factors associated with and the significance of lacking biopsy for long-term outcome. Predictors and the importance of incomplete histological recovery after 1 year was investigated in re-biopsied patients.



A total of 760 patients participated in a nationwide follow-up study. Medical data were gathered via interviews and patient records, and blood samples were drawn for serology. Current symptoms and well-being were assessed by validated PGWB, SF-36 and GSRS questionnaires.



Malabsorption was more common among those with a repeat biopsy (46%) than those without repeat biopsy (33%), P < 0.001, as were severe symptoms at diagnosis (24% vs. 16%, P = 0.05) and concomitant gastrointestinal (40% vs. 32%, P = 0.049) or musculoskeletal (35% vs. 27%, P = 0.023) diseases such as arthritis, osteoporosis and back pain. Repeat biopsy was more rare in subjects diagnosed in private care (11% vs. 23%, P < 0.001) or by screening (10% vs. 16%, P = 0.010). The groups were comparable as to current symptoms and dietary adherence, but those without re-biopsy were less confident of their diet (89% vs. 94%, P = 0.002) and more often seropositive on diet (14% vs. 9%, P = 0.012). They reported better SF-36 physical functioning (P = 0.043) and less pain and indigestion (P = 0.013 and P = 0.046 respectively) and total GSRS (P = 0.052) score. Incomplete mucosal recovery was predicted by more advanced histological (P < 0.001) and serological (P = 0.001) disease at diagnosis, whereas the groups did not differ in long-term adherence, symptoms, seropositivity, questionnaire scores, frequency of fractures or malignancies.



Severe disease at diagnosis predicted the record of a repeat biopsy and incomplete mucosal recovery. Neither lacking biopsy nor incomplete recovery in a relative short time span of 1 year was associated with poorer long-term outcome, although survival bias cannot be excluded.
The Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
H
H
Pekki
Tampere Center for Child Health, University of Tampere and Tampere University Hospital, Tampere, Finland.
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0000-0003-4757-2164
K
Kurppa
Tampere Center for Child Health, University of Tampere and Tampere University Hospital, Tampere, Finland.
M
M
Mäki
School of Health Sciences, University of Tampere, Tampere, Finland.
H
H
Huhtala
Tampere Center for Child Health, University of Tampere and Tampere University Hospital, Tampere, Finland.
K
K
Laurila
Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.
T
T
Ilus
The Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.|Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
K
K
Kaukinen
D000328:Adult; D001706:Biopsy / Q000379:methods*; D002446:Celiac Disease / Q000175:diagnosis / Q000178:diet therapy*; D003430:Cross-Sectional Studies; D055050:Diet, Gluten-Free; D004415:Dyspepsia; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires