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QUESTION: I saw Dr. Rudert speak at the CSA conference in Atlanta, and I have a question about something she said. I believe that she said the serology tests will only be positive if a patient has complete villous atrophy. Does that mean they are not valuable for checking patient compliance with the diet after all?

DR. RUDERT: I was pleased to be invited to participate in the first meeting of what became the Celiac Standardization Group. Thanks to Elaine Gottschall from the Celiac Disease Foundation, a group of researchers and clinicians interested in Celiac Disease from both the United States and Europe met in February of 1999. The topic was "Serologic Testing in Celiac Disease."

During this meeting I learned that endomyosial antibody positivity correlates with total villous atrophy. Partial villous atrophy has not been studied and the correlation with endomyosial antibody positivity and partial or subtotal villous atrophy is unknown.

The question posed... "Does that mean they are not valuable for checking patient compliance with the diet after all?" In a nutshell my answer is as follows: If one or more of your blood tests were positive and you have biopsy confirmed Celiac Sprue, then most certainly they can be used to follow dietary compliance.

The anti-reticulin antibody is generally the first to normalize and can do so as early as two weeks. Obviously, if you are not anti-reticulin antibody positive, your blood tests may take longer to normalize and vary according to the individual and possibly the degree of intestinal damage.

I generally repeat blood testing within six months to one year; however, of course, this would most certainly vary depending upon the individual patient. My preference by far is to follow individuals clinically and I like to see all of my patients with Celiac Disease at least every three to four months to keep them updated about the new research that may become available in addition to updates regarding dietary information.

There is, however, a subset of individuals that are sero-negative (meaning that all blood tests are negative and their small bowel biopsy is positive), and therefore, with this population repeat testing would not be of benefit. It would always be important to repeat your blood testing with the same lab that you initially had used since there is most certainly variability from lab to lab.