Diagnosing coeliac disease: Out with the old and in with the new?

The Yin and Yang of dietary gluten transgressions in real-life scenarios of celiac patients

“…Strict compliance is challenging since GFD infringement is influenced by psychological, emotional, and social factors, age and way of diagnosis (by screening or clinical suspicion), knowledge of the disease, and eating habits. The contradictory performances of serology [2,4] and follow-up biopsy [2,5] as a monitory means of compliance were described above. Recently, two additional, more objective ways to detect dietary gluten transgressions using gluten immunogenic peptide excretion in urine and stool have been described [10].…”

“…From the CD perspective, diagnosis is based on a combination of clinical symptoms, serology, genotyping, and intestinal histology [2]. Presenting symptoms are manifold.…”

“…Patients should be on a gluten-containing diet and IgA deficiency should be excluded. Antibody sensitivity is lower in a milder intestinal pathology, and even the most frequently used antibody, IgA anti-tissue transglutaminase, can present with multiple false positives and negatives [2,4]. HLA-DQ2/8 negativity is used to rule out a diagnosis of CD but positivity is only confirmative and cannot be used as a first-line test [2].…”

“…In the past, histology was conclusive and necessary for a definitive diagnosis. However, in recent years, ambiguity has arisen due to significant inter-observer disagreement, the patchy histological presentation, shared features with multiple gastrointestinal conditions, and inaccuracy in milder damage [2,5]. Due to the complexity of the disease and the controversies surrounding its classification and diagnosis, it is apparent that not a single test will make an accurate diagnosis.…”

“…Due to the complexity of the disease and the controversies surrounding its classification and diagnosis, it is apparent that not a single test will make an accurate diagnosis. Therefore, a combined holistic approach to improve and standardize the CD diagnoses is urgently required [2]. Intriguingly, CD nutritional therapy is in no way less ambiguous.…”