Which statement is true regarding monitoring coeliac disease after a gluten-free diet?

Which statement is true regarding monitoring coeliac disease after a gluten-free diet?

• A. IgA Tissue Transglutaminase antibody is used to monitor disease activity
• B. Endomysial antibodies are the preferred monitoring test
• C. Total IgA is sufficient for monitoring
• D. No serologic test is useful for monitoring

Answer: (A)

Tracking response to a gluten-free diet in celiac disease relies on serology, especially the IgA tissue transglutaminase antibody. This marker is highly sensitive and specific for active disease and typically declines toward normal as people adhere strictly to a gluten-free diet and the intestinal mucosa heals. If the tTG IgA level remains elevated or rises, it suggests ongoing gluten exposure or a potential complication, prompting a closer look at dietary adherence and further evaluation. Endomysial antibodies are very specific but are not practical for routine monitoring and are more often used in diagnostic workups rather than follow-up. Measuring total IgA serves to detect IgA deficiency, which can cause false-negative tTG IgA results; in individuals with IgA deficiency, monitoring relies on IgG-based tests (such as tTG IgG or deamidated gliadin peptide IgG). Keep in mind that serology is a useful guide, but it may not perfectly reflect mucosal healing, so clinical assessment and, in some cases, repeat biopsy are considered.

Tracking response to a gluten-free diet in celiac disease relies on serology, especially the IgA tissue transglutaminase antibody. This marker is highly sensitive and specific for active disease and typically declines toward normal as people adhere strictly to a gluten-free diet and the intestinal mucosa heals. If the tTG IgA level remains elevated or rises, it suggests ongoing gluten exposure or a potential complication, prompting a closer look at dietary adherence and further evaluation. Endomysial antibodies are very specific but are not practical for routine monitoring and are more often used in diagnostic workups rather than follow-up. Measuring total IgA serves to detect IgA deficiency, which can cause false-negative tTG IgA results; in individuals with IgA deficiency, monitoring relies on IgG-based tests (such as tTG IgG or deamidated gliadin peptide IgG). Keep in mind that serology is a useful guide, but it may not perfectly reflect mucosal healing, so clinical assessment and, in some cases, repeat biopsy are considered.