This blog entry has abbreviated/summarized this presentation. Though not intentional, some important material is likely to have been omitted; in addition, transcription errors are possible as well.

Celiac disease: treat to target! Where should we aim and how do we get there?

Ivor Hill  Nationwide Children’s Hospital

Key point:

• Dr. Hill asserted that long-term outcomes are related to ongoing intestinal inflammation and thus our goal should be mucosal healing rather than normalized symptoms/normalized serology

At this lecture, I asked Dr. Hill what he would recommend for an asymptomatic pediatric patient with ongoing intestinal inflammation who was strictly adherent to a gluten-free diet, who had no other recognizable diseases, and who had normalized their serology on treatment.  His response was that in adults that ~50% of patients improve with better attention to diet.  Thus, currently besides further dietary scrutiny, it is unclear what should be done in the pediatric population should one find ongoing mucosal disease in an asymptomatic adherent patient.

My take: Until prospective pediatric studies are published to determine the frequency of ongoing intestinal inflammation in those on a strictly GFD in asymptomatic patients and until we have additional management options, it does not make sense to look for mucosal healing.  “Don’t hunt what you cannot kill.”

Related blog posts:

• >99% Accuracy in Non-biopsy diagnosis of celiac disease
• Followup Biopsies in Pediatric Celiac Disease?
• How Slow Do Objective Markers of Celiac Change After Treatment? | gutsandgrowth
• Are followup biopsies necessary in celiac disease? Look beyond the headlines
• To biopsy or not to biopsy -that is the question (for Celiac disease)
• How Accurate is Serology at Predicting Mucosal Healing in Celiac Disease
• Drug Therapy for Celiac Disease | gutsandgrowth
• Why is Celiac Disease Becoming More Prevalent? | gutsandgrowth
• Benefits of Gluten–Free Diet for “Asymptomatic” Celiac | gutsandgrowth
• Closer followup for Celiac disease & pediatric … – gutsandgrowth

Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.