What should be our goal when treating patients with celiac disease? Is it the absence of villous atrophy or normalization of intraepithelial lymphocytes count?
Paul Moayyedi: It is a good question which I do not think we know the answer to. What we are really trying to avoid here is the long-term complications: the risk of gastrointestinal (GI) cancer and lymphoma, which are probably inflammatory-mediated.
Looking at atrophy is probably not the main goal. Inflammation in general, so removing the excess of intraepithelial lymphocytes, is probably the goal, although to completely normalize things is the Holy Grail – it is rarely achieved, and I am not sure we should get too obsessed with that. If there is just a mild increase in intraepithelial lymphocytes that is probably what we want to aim for.