To biopsy or not to biopsy: that is the question

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...
Source: Gut - Category: Gastroenterology Authors: Tags: Gut Commentary Source Type: research