Optimising the follow-up of adult coeliac disease with a clinical-based score to identify patients in need of a histological reassessment: A retrospective single centre study

Gaia Harder, Annalisa Schiepatti, Federico Biagi, Federica Borrelli De Andreis, Simona Agazzi, Gianmarco Gabrielli, Catherine Klersy

Research output: Contribution to journalArticle

Abstract

Follow-up modalities for adult coeliac patients remain controversial. Non-invasive markers to identify coeliac patients on a gluten-free diet (GFD) with persistence of villous atrophy (VA) are still lacking. We aim to develop a score to stratify coeliac patients on a GFD according to their risk of having persistent VA and to tailor follow-up modalities accordingly. The clinical notes of more than 700 coeliac patients attending our unit between September 1999 and November 2018 were retrospectively examined. 273 patients on a GFD with a histological follow-up performed 12-24 months after diagnosis were selected. We developed a bivariable model based on diet adherence and clinical response evaluated by previously validated methods. A four level score (0.5, 1.5, 3, 4) was obtained. Patients on a strict GFD and with good clinical conditions (score 4) have a very low risk of persistence of VA (2 %, 95 % CI 1, 5). Conversely, the risk is very high (46 %, 95 % CI 25, 68) in patients with poor adherence to a GFD and unsatisfactory clinical response (score 0.5). A score of 1.5 (poor GFD adherence and persistent well-being) is linked with a high risk (23 %, 95 % CI 14, 36). Risk is intermediate (6 %, 95 % CI 3, 10) in patients scoring 3 (strict GFD and no/partial clinical improvement). Three patients who developed complications belonged to this scenario. Patients at low risk of persistent VA can be followed-up non-invasively, whereas a biopsy should be repeated in those at high/very high risk. Case-by-case evaluation is needed in patients at intermediate risk. Studies on a larger sample size are required to confirm these data.

Original languageEnglish
JournalBritish Journal of Nutrition
DOIs
Publication statusAccepted/In press - Jan 1 2020

Keywords

  • Celiac disease
  • Duodenal biopsy
  • Endomysial antibody
  • Gluten-free diet
  • Tissue transglutaminase

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

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