<<Disclaimer: Verify this information before applying it to your situation.>>

Hello friends,

I received ten replies to my query regarding whether or not to expect a
follow-up biopsy as a matterof routine.

Follow-up biopsies after adhering to a gluten free diet are only done
when the patient is not feeling improvement.  Typically, people do feel
better on a GF diet, and therefore, the biopsy is not needed.  The risk
of the procedure far outweighs the benefit of the test.

Rather, the blood antibody tests are the way to go for a follow-up--far
less risk for a similar result.

A well-worded response which sums this up:

  "Our local expert says the proof of the diagnosis is that you improve on the
  diet.  If improvement is not evident, they need to rebiopsy to make sure the
  villi is improving--confirms the diagnosis & lets them know they need to
look
  for further problems, or is not improved--diet bad or wrong diagnosis to
  start with...

  Once gluten in elminated from the diet, traces amounts of gluten often seem
  to cause a worse reaction as tolerance levels seem to reset to object to
  trace amounts.   Several newly diagnosed celiacs in our group have had
higher
  levels on blood tests after being on the diet for a time (less tolerance) &
  have needed to reevaluate their diets, so that might be a more accurate
check
  of dietary compliance.  GI tract will probably look improved just because
  less gluten is hitting it. "

Another reply from a physician with celiac:

  "If your antibody levels were initially elevated and are now back down in
  normal range then the consensus that I have read is no biopsy necessary.
  The IgG (anti-) gliadin is the best antibody to look for occult gluten
  ingestion.

  As to time frame for repeat biopsy, studies have shown that it can take
  years of GF diet for the infiltrative lesion to resolve (the so-called
  intraepithelial lymphocytosis).  The crypt hyperplasia and villous
  flattening as well as the severe inflammation will resolve over a few months
  (6 usually quoted).

  If you are completely symptom free and negative antibodies then most GIs
  would be OK with that."


Thanks for your replies, and I hope this helps!


Chris Gralapp, MA, CMI
Medical and Scientific Illustration
415.454.6567
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www.biolumina.com