Antibody titers against food antigens decrease upon a gluten-free diet, but are not useful for the follow-up of (refractory) celiac disease

Celiac disease (CD) is an autoimmune disease characterized by intestinal mucosal damage as a consequence of a hypersensitivity to dietary gluten peptides. A gluten-free diet (GFD) reduces symptoms in the majority of patients within weeks to months 1. However, intestinal mucosal recovery lags behind the clinical response 2. There are indications that these histologically slow-responding patients have a poor prognosis 3. Therefore, follow-up of mucosal recovery is required in CD patients. As biopsies are expensive and invasive, in clinical practice, the decrease in antibodies against tissue transglutaminase (TG2A) is often used as an indicator of mucosal recovery. However, the use of only TG2A as a marker may not be specific enough for the estimation of mucosal recovery 4. Thus, [...]

In conclusion, although ABSA and ASCA levels are elevated in CD and RCD-II patients and ASCA decrease differentially upon treatment, they are not useful for the follow-up of individual patients.