Monitoring
There are no clear recommendations for monitoring patients during treatment of TS. The majority of patients will experience an abrupt clinical response to treatment with a decrease in diarrhoea, an increase in weight, and an improvement in well-being within 2 to 6 weeks of starting treatment. The volume of steatorrhoea, degree of D-xylose malabsorption, folate levels, and degree of macrocytic anaemia should all improve within 1 to 3 weeks of initiating treatment. There is no indication to monitor these parameters with ongoing tests. Repeating endoscopic biopsy while the patient is receiving treatment is not currently recommended as there is poor correlation between clinical status and histology. If repeat biopsies are taken, improved histology should be expected within 3 months and a return to normal should be seen by 1 year.
One study suggests that although clinical and subjective parameters improve after treatment with tetracycline, up to two-thirds of patients still manifest evidence of abnormal small intestinal permeability. As such, one can consider periodic monitoring for evidence of malabsorption and nutrient deficiencies.[18]
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