DÄ internationalArchive27/2010No Follow-Up Endoscopy
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Lübbers and colleagues recommend a follow-up biopsy in patients with celiac disease in order to confirm a successful gluten-free diet. The members of the scientific advisory board of the German Coeliac Society (Deutsche Zöliakie-Gesellschaft, DZG) do not share this view, for the following reasons:

The guidelines of the European Society for Paediatic Gastroenterology, Hepatology and Nutrition (ESPGHAN) (1) agree that patients who respond to a gluten-free diet and report no further complaints do not require a repeat biopsy. Clinical and serological (IgA-transglutaminase antibodies) follow-up are sufficient. In contrast to what is said in the article, asymptomatic patients who are in serological remission while adhering to a gluten-free diet do not require follow-up endoscopy either. A repeat biopsy is recommended only in patients who have not responded to the diet clinically and/or serologically. Several working groups have shown that it can take several years for adult patients adhering to a gluten-free diet to achieve normalization of the mucosa. After 12 months, some 30% of patients still had a Marsh-III lesion (2). Repeated esophagogastroduodenoscopy may therefore not only be superfluous but also misleading. Further, the authors cited a review article (3) and adapted a figure (Figure 2) in such a way that its meaning is completely different. In the original figure, follow-up biopsy is explicitly not recommended in patients with a confirmed diagnosis. Readers may thus have gained the erroneous impression that Holtmeier in his review article recommended a follow-up biopsy.

DOI: 10.3238/arztebl.2010.0492b

W. Holtmeier and K.-P. Zimmer on behalf of the scientific advisory board of the German Coeliac Society

PD Dr. med. Wolfgang Holtmeier
Klinik für

Gastroenterologie, Diabetologie und Innere Medizin

Krankenhaus Porz am Rhein

Urbacher Weg 19, 51149 Köln, Germany
w.holtmeier@khporz.de

1.
Walker-Smith JA, Guandalini S, Schmitz J, Shmerling DH, Visakorpi JK: Revised criteria for diagnosis of coeliac disease. Arch Dis Child 1990; 65: 909–11. MEDLINE
2.
Kaukinen K, Sulkanen S, Maki M, Collin P: IgA-class transglutaminase antibodies in evaluating the efficacy of gluten-free diet in coeliac disease. Eur J Gastroenterol Hepatol 2002; 14: 311–5. MEDLINE
3.
Holtmeier W: Diagnosis of celiac disease. Z Gastroenterol 2005; 43: 1243–52. MEDLINE
4.
Lübbers H, Mahlke R, Lankisch PG, Stolte M: Follow-up Endoscopy in Gastroenterology: When is it helpful? [Kontrollendoskopie in der Gastroenterologie: Sinnvoll oder Ballast?]. Dtsch Arztebl Int 2010; 107(3): 30–6 VOLLTEXT
1. Walker-Smith JA, Guandalini S, Schmitz J, Shmerling DH, Visakorpi JK: Revised criteria for diagnosis of coeliac disease. Arch Dis Child 1990; 65: 909–11. MEDLINE
2. Kaukinen K, Sulkanen S, Maki M, Collin P: IgA-class transglutaminase antibodies in evaluating the efficacy of gluten-free diet in coeliac disease. Eur J Gastroenterol Hepatol 2002; 14: 311–5. MEDLINE
3. Holtmeier W: Diagnosis of celiac disease. Z Gastroenterol 2005; 43: 1243–52. MEDLINE
4.Lübbers H, Mahlke R, Lankisch PG, Stolte M: Follow-up Endoscopy in Gastroenterology: When is it helpful? [Kontrollendoskopie in der Gastroenterologie: Sinnvoll oder Ballast?]. Dtsch Arztebl Int 2010; 107(3): 30–6 VOLLTEXT