Does treatment of coeliac disease require full mucosal recovery?

Glutenfree diet is recommended for all coeliacs. There are almost no data on effective means of monitoring coeliacs. Some consider a decrease in antibody titer as an indication of dietary adherence. A recent American pediatric guideline suggests that additional biopsies are not recommended. The UEGW group about adult coeliacs advises a second biopsy after one year. The required normalisation has not been defined. Serology does not indicate complete mucosal recovery and cannot substitute for follow-up biopsy. Biopsy findings may not always be as conclusive as is imaging in explaining persistent complaints in coeliacs. Treating almost daily refractory coeliacs on their way to EATL, we suggest mucosal recovery is the only protection against such complications, especially in coeliacs diagnosed above the age of 50, so-called old-age coeliacs. A body of published data is mandatory to see if full mucosal recovery is required and is achievable. In countries where gluten-free products are not easily available as in Eastern Europe or the Middle East, this might be extremely difficult for the coeliacs, their doctors and dietitians.