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The debate on the necessity of follow-up biopsy in coeliac disease has been ongoing for decades. The follow-up biopsy was dropped largely to reduce the burden of diagnosis and management in children. However, with the appreciation that coeliac disease can present in adulthood and is often associated with complications pertinent to the adult disease, it inherently is a more chronic inflammatory disorder in adults where healing is neither rapid nor assured—and in some circumstances, even frequent. The management of other classic chronic inflammatory gastrointstinal disorders, particularly Crohn’s disease and ulcerative colitis, has slowly evolved to now treating inflammation to achieve remission both defined by endoscopy and histology. However, in adult coeliac disease, we have largely eshued that management step. Is this lack of attention due to a lack of recognition of the importance of healing in coeliac disease? Decidedly not. Many guidelines attest to the importance of achieving healing in coeliac disease.1 2 However, they do not embrace the concept of routine rebiopsy in patients with coeliac disease when diagnosed as adults. In fact even in children now, often times the diagnostic biopsy is entirely dispensed with.3 Why is there active determination of healing in patients with inflammatory bowel disease and not …
Contributors JAM is the sole author of the Gut Commentary.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests JAM reports Grants (to Institution) from Nexpep/ImmusanT, National Institutes of Health, Immunogenix, Takeda Pharmaceutical, Allakos, ProventionBio, Oberkotter Foundation, and 9Meters; Contract (to Institution) from Kanyos Bio (a wholly owned subsidiary of Anokion); and Consultancy Fees from Johnson and Johnson, Bristol Myers Squibb, Intrexon Corporation, Dren Bio, Neoleukin, Reistone Pharma, Immunic Therapeutics, Senda Biosciences, Brightseed Bio, Chugai Pharma, Alimentiv, Equillium, Ukko, Medibeacon, Precigen, Triangle Insights Group, Sanofi and Orbimed; and has received Royalties from Torax Medical and Evelo.
Provenance and peer review Commissioned; internally peer reviewed.