Abstract
Background: Convincing evidence is lacking on the benefit of follow-up biopsy in celiac disease. Regardless, achieving mucosal recovery (MR) has remained a desirable goal of therapy. We aimed to conduct a systematic review to determine whether MR is a protective factor and persisting villous atrophy (PVA) has negative consequences on long-term outcomes of celiac disease.Methods: Seven databases were searched for articles discussing celiac patients subjected to a gluten-free diet who had a follow-up biopsy, and clinical and laboratory characteristics were reported by follow-up histology (MR vs. PVA). Outcomes included clinical symptoms, mortality, malignant tumors, nutritional parameters, and metabolic bone disease. Comparative and descriptive studies were included. Since data proved to be ineligible for meta-analysis, the evidence was synthesized in a systematic review.Results: Altogether, 31 studies were eligible for systematic review. Persisting symptoms were more frequently associated with PVA than with MR, although a lot of symptom-free patients had PVA and a lot of symptomatic patients achieved MR. PVA might be a risk factor of lymphomas, but mortality and the overall rate of malignant tumors seemed independent of follow-up histology. Patients with PVA tended to develop metabolic bone disease more often, although fracture risk remained similar in the groups except in hip fractures of which PVA was a risk factor. Reports on nutritional markers are only anecdotal.Conclusions: The limited evidence calls for high-quality prospective cohort studies to be arranged to clarify the exact role of follow-up histology in celiac disease.
Highlights
Celiac disease (CeD) is a systemic disorder with an increasing worldwide prevalence of ∼1% (Di Sabatino and Corazza, 2009; Catassi et al, 2014)
Achieving mucosal recovery (MR) is a desirable goal of treatment
findings of reports which investigated its beneficial effects on disease course are inconsistent
Summary
Celiac disease (CeD) is a systemic disorder with an increasing worldwide prevalence of ∼1% (Di Sabatino and Corazza, 2009; Catassi et al, 2014). While the restitution of intestinal villi is expected on a strict gluten-free diet, the mucosa fails to restore entirely in a considerable fraction of patients (Szakacs et al, 2017). Recent guidelines recommend a followup biopsy if signs and symptoms persist or relapse despite strict adherence to a gluten-free diet (Bai et al, 2013; RubioTapia et al, 2013; Ludvigsson et al, 2014). One might expect that CeD patients with persistent villous atrophy (PVA) experience a less favorable disease course than those achieving MR (Haines et al, 2008), convincing evidence is lacking. Convincing evidence is lacking on the benefit of follow-up biopsy in celiac disease. Regardless, achieving mucosal recovery (MR) has remained a desirable goal of therapy. We aimed to conduct a systematic review to determine whether MR is a protective factor and persisting villous atrophy (PVA) has negative consequences on long-term outcomes of celiac disease
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