Follow-up modalities for adult coeliac patients remain controversial. Non-invasive markers to identify coeliac patients on a gluten-free diet (GFD) with persistence of villous atrophy (VA) are still lacking. We aim to develop a score to stratify coeliac patients on a GFD according to their risk of having persistent VA and to tailor follow-up modalities accordingly. The clinical notes of over 700 coeliac patients attending our unit (September 1999–November 2018) were retrospectively examined. A total of 273 patients on a GFD with a histological follow-up performed 12–24 months after diagnosis were selected. We developed a bivariable model based on diet adherence and clinical response evaluated by previously validated methods. A four-level score (0·5, 1·5, 3, 4) was obtained. Patients on a strict GFD and with good clinical conditions (score 4) have a very low risk of persistence of VA (2 (95 % CI 1, 5) %). Conversely, the risk is very high (46 (95 % CI 25, 68) %) in patients with poor adherence to a GFD and unsatisfactory clinical response (score 0·5). A score of 1·5 (poor GFD adherence and persistent well-being) is linked with a high risk (23 (95 % CI 14, 36) %). Risk is intermediate (6 (95 % CI 3, 10) %) in patients scoring 3 (strict GFD and no/partial clinical improvement). Three patients who developed complications belonged to this scenario. Patients at low risk of persistent VA can be followed-up non-invasively, whereas a biopsy should be repeated in those at high/very high risk. Case-by-case evaluation is needed in patients at intermediate risk. Studies on a larger sample size are required to confirm these data.

中文翻译：

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使用基于临床的评分优化成人乳糜泻的随访以确定需要进行组织学重新评估的患者：一项回顾性单中心研究

成人乳糜泻患者的随访方式仍存在争议。仍然缺乏用于识别持续绒毛萎缩 (VA) 的无麸质饮食 (GFD) 乳糜泻患者的非侵入性标志物。我们的目标是根据患有持续性 VA 的风险对 GFD 上的乳糜泻患者进行分层，并相应地调整随访方式。回顾性检查了就诊于我们单位（1999 年 9 月至 2018 年 11 月）的 700 多名乳糜泻患者的临床记录。总共选择了 273 名 GFD 患者，在诊断后 12-24 个月进行了组织学随访。我们开发了一个基于饮食依从性和临床反应的双变量模型，该模型通过先前验证的方法进行评估。获得了四级分数（0·5、1·5、3、4）。接受严格 GFD 且临床状况良好（评分 4）的患者持续 VA 的风险非常低（2 (95 % CI 1, 5) %）。相反，对于 GFD 依从性差且临床反应不满意（评分 0·5）的患者，风险非常高（46 (95 % CI 25, 68) %）。1·5 分（GFD 依从性差和持续健康）与高风险相关（23 (95 % CI 14, 36) %）。在评分为 3 的患者（严格的 GFD 和无/部分临床改善）中，风险为中等（6 (95 % CI 3, 10) %）。三名出现并发症的患者属于这种情况。持续性 VA 风险低的患者可以进行无创随访，而高/极高风险患者应重复活检。中危患者需要逐案评估。需要对更大样本量的研究来确认这些数据。