Clinical Features of Celiac Disease Today

Abstract

The clinical spectrum of celiac disease has widened over the past decades. The condition is no longer a severe malabsorption syndrome. Instead, a typical celiac disease patient today has merely mild abdominal symptoms. Malabsorption can be subclinical or absent, and there is usually only moderate, if any, loss of weight. Simultaneously, the current prevalence has increased from 1:1,000 to 1:300 inhabitants, or even higher. Clinically silent celiac disease cases are being detected in increasing numbers since the introduction and widespread use of serologic screening tests. Symptoms of celiac disease can appear outside the intestine, a typical example being dermatitis herpetiformis. Gluten intolerance is no longer limited to overt villous atrophy. Inflammation without villous damage may be observed in genetically susceptible individuals. The term latent celiac disease is applied in situations where the patient has normal villous architecture while on a gluten-containing diet, but later develops small bowel villous atrophy compatible with celiac disease.

Celiac disease diagnosis and gluten-free food analytical control

“…They do not have a flat mucosa, despite a gluten-containing diet, but probably will develop clinically overt CD later in life [20][21][22]. These patients usually present increased intraepithelial lympho-cytes (IELs) and positive serology for endomysial anti-bodies (EMA) and tissue transglutaminase (tTG) antibodies with HLA-DQ2 or DQ8 predisposing genotype [23][24][25].…”

“…In fact, currently, there are more subjects with asymptomatic or mild celiac disease than with the classic symptoms of severe malabsorption [3,21].…”

Some aspects of food allergy

“…Coeliac disease due to gluten sensitivity is a classic example 6 . Other food allergens include cow milk, soya, egg, rice, fish and chicken.…”

“…Protracted diarrhoea, malabsorption, steatorrhoea, abdominal distension and failure to thrive are common clinical manifestations 6 . Antigliadin and antiendomysium antibodies are detected in the serum in 90% of patients 6 . A gluten-free diet should be prescribed life-long.…”

“…A gluten-free diet should be prescribed life-long. It is associated with HLA -DQ2(&DQ8) haplotype 6 .…”