A Call for Research on the Prognostic Role of Follow-Up Histology in Celiac Disease: A Systematic Review

Zsolt Szakács, Noémi Gede, Zoltán Gyöngyi, Margit Solymár, Dezső Csupor, Bálint Erőss, Áron Vincze, Alexandra Mikó, Andrea Vasas, László Szapáry, Dalma Dobszai, Viktória Balikó, Roland Hágendorn, Péter Hegyi, Judit Bajor

Research output: Contribution to journalReview article


Background: Convincing evidence is lacking on the benefit of follow-up biopsy in celiac disease. Regardless, achieving mucosal recovery (MR) has remained a desirable goal of therapy. We aimed to conduct a systematic review to determine whether MR is a protective factor and persisting villous atrophy (PVA) has negative consequences on long-term outcomes of celiac disease. Methods: Seven databases were searched for articles discussing celiac patients subjected to a gluten-free diet who had a follow-up biopsy, and clinical and laboratory characteristics were reported by follow-up histology (MR vs. PVA). Outcomes included clinical symptoms, mortality, malignant tumors, nutritional parameters, and metabolic bone disease. Comparative and descriptive studies were included. Since data proved to be ineligible for meta-analysis, the evidence was synthesized in a systematic review. Results: Altogether, 31 studies were eligible for systematic review. Persisting symptoms were more frequently associated with PVA than with MR, although a lot of symptom-free patients had PVA and a lot of symptomatic patients achieved MR. PVA might be a risk factor of lymphomas, but mortality and the overall rate of malignant tumors seemed independent of follow-up histology. Patients with PVA tended to develop metabolic bone disease more often, although fracture risk remained similar in the groups except in hip fractures of which PVA was a risk factor. Reports on nutritional markers are only anecdotal. Conclusions: The limited evidence calls for high-quality prospective cohort studies to be arranged to clarify the exact role of follow-up histology in celiac disease.

Original languageEnglish
Article number1408
JournalFrontiers in Physiology
Publication statusPublished - Nov 19 2019



  • celiac disease
  • follow-up biopsies
  • gluten-free diet
  • mucosal recovery
  • persistent villous atrophy

ASJC Scopus subject areas

  • Physiology
  • Physiology (medical)

Cite this

Szakács, Z., Gede, N., Gyöngyi, Z., Solymár, M., Csupor, D., Erőss, B., Vincze, Á., Mikó, A., Vasas, A., Szapáry, L., Dobszai, D., Balikó, V., Hágendorn, R., Hegyi, P., & Bajor, J. (2019). A Call for Research on the Prognostic Role of Follow-Up Histology in Celiac Disease: A Systematic Review. Frontiers in Physiology, 10, [1408]. https://doi.org/10.3389/fphys.2019.01408