Abstract
Simple SummaryCoeliac disease is a common chronic enteropathy that may lead to severe complications, including refractoriness (i.e., nonresponsiveness to a gluten-free diet) and enteropathy-associated T-cell lymphoma. In this study, we found that two serum markers, namely chromogranin A and β2-microglobuline, can predict these complications in patients with coeliac disease.The persistence or recurrence of symptoms in patients with coeliac disease (CD), despite a gluten-free diet (GFD), must prompt further work-up for excluding refractory CD (RCD). The aim of this study was to assess the accuracy of serum markers in predicting refractoriness in CD patients. This study included 72 patients affected by CD followed-up at our center, namely 49 uncomplicated CD before and after GFD and 23 RCD. Serum levels of chromogranin A (CgA) and β2-microglobuline were measured at baseline and at follow-up (median time of 13 months) in each group of patients. Cut-off points for each marker were estimated to differentiate RCD from uncomplicated CD patients. Serum levels of CgA and β2-microglobuline were significantly higher in patients with RCD compared to uncomplicated CD (p < 0.001), both at baseline and at follow-up, with no significant difference between RCD type 1 and type 2. The estimated cut-off point for CgA was 90.2 ng/mL (sensitivity 83%, specificity 100%), while for β2-microglobuline it was 696 mcg/L (sensitivity 100%, specificity of 100%). To conclude, CgA and β2-microglobuline could be useful serological markers of refractoriness in CD, with the ability to discriminate those patients who should undergo upper gastrointestinal endoscopy for making a definite diagnosis.
Highlights
Coeliac disease (CD) is a chronic immune-mediated intolerance to gluten proteins that causes villous flattening of the small bowel mucosa in genetically susceptible individuals [1,2]
The baseline for uncomplicated CD was the time of diagnosis of CD, when these patients had not yet followed a glutenfree diet (GFD). the follow-up for uncomplicated CD patients was made at least after 12 months of a GFD
With the aim of identifying serum markers that can predict refractoriness in patients with CD, serum levels of chromogranin A (CgA), β2-microglobuline, lactate dehydrogenase (LDH), and albumin were measured at baseline in 72 patients affected by CD, and divided into three groups: patients with refractory CD (RCD), patients with uncomplicated CD before GFD, and the same uncomplicated CD patients in whom the response to GFD was ascertained histologically after at least 12 months (defined from here onwards as treated CD (TCD))
Summary
Coeliac disease (CD) is a chronic immune-mediated intolerance to gluten proteins that causes villous flattening of the small bowel mucosa in genetically susceptible individuals [1,2]. The only effective available treatment for CD is a life-long, strict, glutenfree diet (GFD), which is able to restore small bowel mucosa integrity in most cases, ameliorating most of CD-related clinical manifestations [8,9], and preventing possible complications, some of them potentially life-threatening, such as refractory CD (RCD), ulcerative jejunoileitis, and enteropathy-associated T-cell lymphoma (EATL) [10]. RCD is characterized by the absence of clinical and histological (i.e., recovery of villous atrophy) response after at least 12 months of a strict GFD, in the absence of overt malignancy [11]. Novel therapies for the treatment of RCD are currently under investigation [12]
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