Biopsieren vs. Nichtbiopsieren bei Zöliakie

Most of the actual guidelines recommend performing duodenal histology for the diagnosis of celiac disease in adults. A recently published study showed that a no-biopsy diagnostic approach is also feasible in adult patients, especially if serum tTG-IgA (tissue transglutaminase IgA antibodies) levels are at least 10 times the upper normal value. A persistent villous atrophy (pVA) is associated with an increased risk for celiac disease-associated complications and mortality. As part of another recent study, a 5-point scale was successfully developed to identify high-risk patients for pVA who should be followed up with duodenal biopsies. The score includes an age at diagnosis ≥ 45 years, a classic clinical presentation of celiac disease, lack of clinical improvement with the gluten-free diet (GFD), and poor adherence to the GFD. The persistent gluten exposure is the most significant risk factor for a pVA in patients with celiac disease. Stool- or urine gluten immunogenic peptides (u-GIP) can be used to monitor adherence to the GFD. In another recently published study serially measured u‑GIP significantly predicted persistent villous atrophy, thus providing useful data on diet adherence and duodenal mucosal healing. The study results presented in detail here impressively demonstrate the current possibilities for an individualized celiac disease management.