Pekki et al listed a number of factors associated with incomplete mucosal recovery in a patient with celiac disease who is on a strict gluten-free diet. Incomplete mucosal recovery does not affect clinical symptoms, the patient’s quality of life, or long-term prognosis. The authors are from University of Tampere and UKK Institute in Tampere, Finland.
Patient selection: celiac disease on a gluten-free diet
Assessment: follow-up duodenal biopsies
Follow-up should be individualized and should allow for clearance of antibody and regeneration of the mucosa. It takes about 5 half-lives to clear a substance and IgG antibodies have a relatively long half-life. In addition, T-cells can live for some time.
A person who is strictly adherent to the gluten-free diet may have incomplete mucosal recovery if the peson has more severe celiac disease, with any of the following at diagnosis:
(1) severe mucosal damage
(2) high antibody concentrations
(3) moderate to severe malabsorption
The differential diagnosis includes exposure to a source of gluten (medications, unexpected dietary source, not truly adherent).
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