Limitations of Faecal Calprotectin in Detecting Histological Changes and Persistent Villous Atrophy in Patients With Coeliac Disease on a Gluten-Free Diet

Faecal calprotectin is used to assess intestinal inflammation, but its role in monitoring mucosal healing in coeliac disease is unclear. This study followed 48 adults with coeliac disease on a gluten-free diet over 12 months, evaluating faecal calprotectin levels in correlation with anti-transglutaminase antibodies, gluten-free diet adherence by dietary questionnaires and histology. Although significant histological lesions (Marsh II–III) decreased from 24% to 10%, faecal calprotectin levels fluctuated without correlation to anti-transglutaminase, adherence or histological remission, and did not differentiate between lesion grades. Our findings underscore faecal calprotectin's unreliability in monitoring mucosal healing in adults with coeliac disease, highlighting the urgent need for alternative biomarkers.