Introduction Most complications in coeliac disease appear to be secondary to small intestinal disease, and assessment of this is therefore essential in monitoring coeliac disease status. Recent studies have suggested that tissue transglutaminase (tTG) autoantibodies are insufficient for this, highlighting the need for follow-up biopsy. The aims of this study were to evaluate the criteria for assessing coeliac disease status and suitability for discharge in long-term coeliac patients and to examine factors associated with risk of morbidity.

Method An prospective analysis was made of coeliac patients who reported being compliant with a gluten-free diet for more than two years. They were seen by a single consultant and had attended a follow-up appointment during a 15 month period. Patients were recommended to have a repeat duodenal biopsy and other evaluations, including tissue tTG serology, other blood tests and bone densitometry.

Results 81 patients were reviewed, with 22% not receiving scheduled biopsies, and 2% being unsuitable. Of the 61 patients who had follow-up biopsies, 46 (75%) demonstrated mucosal healing (Marsh grade 0–1). Paired biopsy and IgA serology results were available for 54 patients. Negative tTG IgA antibodies were a poor marker of mucosal healing, with a sensitivity for detecting villous atrophy of 29% and a negative predictive value of 79%. Long-term complication rates, especially low haemoglobin, folate or vitamin D, and reduced bone mineral density, were frequent regardless of mucosal healing. Complication rates were lower in those with mucosal healing (75%) compared to those without (86%), but this was not significant (p=0.50).

Conclusion We confirm that tTG serology is poor at predicting mucosal healing, supporting the use of follow-up biopsy. Decisions regarding healing are difficult to make in patients not wishing to receive follow-up biopsy. Other factors apart from mucosal healing also have importance in the development of complications.