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Gut 55:1037-1046 doi:10.1136/gut.2005.075119
  • Recent advances in clinical practice

Recent advances in coeliac disease

  1. D A van Heel1,
  2. J West2
  1. 1Institute of Cell and Molecular Science, Barts and The London, Queen Mary’s School of Medicine and Dentistry, London, UK
  2. 2Division of Epidemiology and Public Health, University of Nottingham Medical School, Nottingham, UK
  1. Correspondence to:
    Professor D A van Heel
    Institute of Cell and Molecular Science, Barts and The London, Queen Mary’s School of Medicine and Dentistry, Turner St, London E1 2AD, UK; d.vanheel{at}qmul.ac.uk

    The management of coeliac disease is an increasing part of a gastroenterologist’s workload. Recent prevalence studies suggest ∼1% of the general UK population have positive coeliac serology, which combined with increasing population and primary care awareness is leading to more and more referrals. The majority of contemporary referrals are now initially diagnosed by highly sensitive and specific serological tests followed by readily performed endoscopic biopsy (fig 1). Consequently, we now identify many more patients with no or only mild clinical symptoms, making the classical scenario of diarrhoea/steatorrhoea and weight loss a comparative rarity. Much of the early data on clinical aspects of classical coeliac disease (that is, published pre ∼1990) may not be applicable to contemporary coeliac disease. These changes in clinical practice have been paralleled by a dramatic increase in our knowledge of disease pathogenesis, making coeliac disease the best understood human “autoimmune” disorder. In this review article, we present selected major recent advances in both clinical and basic science aspects of coeliac disease, focusing on the many high quality studies published within the last five years.

    Figure 1

     Contemporary and classical diagnosis of coeliac disease. In the past, coeliac disease was mainly diagnosed after clinical presentation. This remains the description of disease in many textbooks. Nowadays, many more patients are referred on the basis of positive serological tests. Endoscopy and “routine” duodenal biopsy (without prior suspicion of coeliac disease) may also lead to diagnosis. *Serology, duodenal histology, HLA-DQ genotyping. Adapted from Green et al 2005.106

    OCCURRENCE OF COELIAC DISEASE

    General population based prevalence studies of undetected coeliac disease

    Several serological screening studies from Europe, South America, Australasia, and the USA have shown that approximately 0.5–1% of these populations may have undetected coeliac disease. The most consistent estimate reported from the largest population based studies is approximately 1%. The prevalence is even higher in first and second degree relatives of people with coeliac …