Year 2020 / Volume 112 / Number 2
Original
The value of a biopsy in celiac disease follow up: assessment of the small bowel after 6 and 24 months treatment with a gluten free diet

101-108

DOI: 10.17235/reed.2019.5947/2018

Amir Sadeghi, Neda Rad, Sara Ashtari, Mohammad Rostami-Nejad, Afshin Moradi, Mahrokh Haghbin, Kamran Rostami, Umberto Volta, Mohammad Reza Zali,

Abstract
Introduction: a routine small bowel biopsy (SBB) during the follow up of celiac disease (CD) is controversial. Little information is available regarding the histological changes during (gluten free diet (GFD) in the long term. Objectives: the aim of the study was to evaluate a novel criterion to compare duodenal histology in CD patients after six months and two years of gluten withdrawal. Methods: this was a cross-sectional study of 200 patients with confirmed Marsh I-III who were under the six months (group A, n = 100) and 24 months (group B, n = 100) of a GFD. Nineteen patients were excluded due to an inadequate adherence to the GFD and another 23 patients were excluded as they were unwilling to undergo a re-endoscopy and did not comply with the necessary criteria. Endoscopy with a duodenal biopsy, serological assays and clinical evaluation were performed and compared with baseline data in the remaining 58 patients (20 patients in group A and 38 patients in group B). Results: a significant complete histological recovery was found in 47.4% of patients in group B compared to 30% in group A (p = 0.026). A partial histological recovery was reported in seven (35%) and eleven (28.9%) patients in groups A and B, respectively. Any changes in mucosal histology after GFD was observed in 35% of patients in group A and 23.7% in group B. Serological assessment and endoscopic appearance normalized in 78.9% vs 75.0% in group B and 68.4% vs 65.0% in group A, respectively. However, this improvement did not reach statistical significance (p > 0.05). Conclusions: the results of this study show that histological recovery in patients with Marsh ≥ III is slow and does not correlate with symptomatic improvement. We suggest that the long-term effects of a GFD can play an important role in achieving histological improvement, especially in older patients.
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Sadeghi A, Rad N, Ashtari S, Rostami-Nejad M, Moradi A, Haghbin M, et all. The value of a biopsy in celiac disease follow up: assessment of the small bowel after 6 and 24 months treatment with a gluten free diet. 5947/2018


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Publication history

Received: 29/09/2018

Accepted: 18/09/2019

Online First: 27/12/2019

Published: 07/02/2020

Article revision time: 345 days

Article Online First time: 454 days

Article editing time: 496 days


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