Performing routine follow-up biopsy 1year after diagnosis does not affect long-term outcomes in coeliac disease

BackgroundA repeat biopsy is recommended, but often omitted in coeliac disease patients on a gluten-free diet. The effect of performing or not performing repeat biopsies is currently unknown. AimTo identify factors associated with and the significance of lacking biopsy for long-term outcome. Predictors and the importance of incomplete histological recovery after 1year was investigated in re-biopsied patients. MethodsA total of 760 patients participated in a nationwide follow-up study. Medical data were gathered via interviews and patient records, and blood samples were drawn for serology. Current symptoms and well-being were assessed by validated PGWB, SF-36 and GSRS questionnaires. ResultsMalabsorption was more common among those with a repeat biopsy (46%) than those without repeat biopsy (33%), P<0.001, as were severe symptoms at diagnosis (24% vs. 16%, P=0.05) and concomitant gastrointestinal (40% vs. 32%, P=0.049) or musculoskeletal (35% vs. 27%, P=0.023) diseases such as arthritis, osteoporosis and back pain. Repeat biopsy was more rare in subjects diagnosed in private care (11% vs. 23%, P<0.001) or by screening (10% vs. 16%, P=0.010). The groups were comparable as to current symptoms and dietary adherence, but those without re-biopsy were less confident of their diet (89% vs. 94%, P=0.002) and more often seropositive on diet (14% vs. 9%, P=0.012). They reported better SF-36 physical functioning (P=0.043) and less pain and indigestion (P=0.013 and P=0.046 respectively) and total GSRS (P=0.052) score. Incomplete mucosal recovery was predicted by more advanced histological (P<0.001) and serological (P=0.001) disease at diagnosis, whereas the groups did not differ in long-term adherence, symptoms, seropositivity, questionnaire scores, frequency of fractures or malignancies. ConclusionsSevere disease at diagnosis predicted the record of a repeat biopsy and incomplete mucosal recovery. Neither lacking biopsy nor incomplete recovery in a relative short time span of 1year was associated with poorer long-term outcome, although survival bias cannot be excluded.