A second duodenal biopsy is necessary in the follow-up of adult coeliac patients

Figures & data

Table I. Clinical and demographic data collected in all coeliac patients.

	Patients, n
Sex
Male	81
Female	236
Diagnosis of CD made in
Our unit in Pavia	254
Other hospital	192
Clinical type of CD at diagnosis
Classical/major	170
Non-classical/minor	111
Asymptomatic/silent	36
EMA/TTA at diagnosis
Positive	316
Negative	1
Duodenal histology at diagnosis
Atrophy (Corazza–Villanacci B1–B2, Marsh–Oberhuber 3a/3c)	317
Preatrophic/infiltrative (Corazza–Villanacci A, Marsh–Oberhuber 1/0)	0^a
Normal	0^a
Endoscopy complications at diagnosis
No	317
Yes	0
Clinical picture at histological follow-up
Persistent well-being^b	34
Complete recovery^c	190
Partial improvement^d	62
No significant improvement^e	31
Gluten-free diet adherence^f
Good	258
Poor	59
EMA at histological follow-up
Positive	78
Negative	242
Endoscopy complications at histological follow-up
Yes	0
No	317
Persistence of villous atrophy at histological follow-up
Yes	25
No	292

CD, coeliac disease; EMA, endomysial antibodies; TTA, tissue transglutaminase antibodies.

^aIt should be noted that patients with potential coeliac disease were excluded (see Methods).

^bAsymptomatic patient at diagnosis.

^cComplete resolution of all the symptoms, laboratory alterations, and nutritional deficiencies present at time of diagnosis of coeliac disease.

^dOnly partial improvement of symptoms, laboratory alterations, and nutritional deficiencies present at diagnosis.

^eNo significant improvement of symptoms, laboratory alterations, and nutritional deficiencies.

^fEvaluation based on a dietary interview performed by expert personnel.

Table II. Sensitivity and specificity of serological response, GFD adherence, and clinical response, correlated with histological response, assumed as gold standard. Although P values for chi-square analyses were statistically significant, from a clinical point of view they were very disappointing.

	Sensitivity	Specificity	P value
Positive endomysial antibodies	48%	71%	< 0.001
Unsatisfactory GFD adherence	64%	80%	< 0.001
Unsatisfactory clinical response	56%	85%	< 0.001

GFD, gluten-free diet.

Figure 1. Kaplan–Meier analysis for cumulative follow-up for the 317 patients who underwent histological re-evaluation calculated from time of diagnosis of coeliac disease until the last time the patient attended our clinic.