How should we monitor mucosal healing in patients with celiac disease?
Paul Moayyedi: To make the diagnosis you have to do an endoscopy, and this will be a duodenal endoscopy, at least in adults. My practice is to follow the patients’ symptoms. If they are completely asymptomatic and do not want any other tests – the patient is always the boss – that is what happens. But if they are happy to have another endoscopy, I will do one, usually one or two years later, on a gluten-free diet, because the mucosal change is slow to regress, so you do not want to do another endoscopy too early, when it does not actually help you.
So you would repeat the endoscopy, as I said, one or two years after a gluten-free diet in those that are willing to have it and certainly in those who have continued symptoms. The other approach is to look at the antibody levels, but that is not really getting at mucosal healing.