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Defining ‘coeliac’: Oslo Accord—or not?
  1. Michael N Marsh
  1. Correspondence to Professor Michael N Marsh, Wolfson College, University of Oxford, Linton Road, Oxford OX2 6UD, UK; mikemarshmd{at}uwclub.net

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The Oslo report1 favours abandoning long-accumulated baggage—‘typical’, ‘atypical’, ‘non-classical’, ‘active’, ‘silent’, ‘potential’. But has Oslo bequeathed us greater definitional incisiveness than either Hawkey2 or Sleisenger and Fordtran3?

First, ‘chronic’?—Why not life-long? ‘Precipitated’—meaning sudden onset?: either when alleged times to diagnosis are ∼10 years or gluten has been ingested for over 60 years? Why not caused? And ‘enteropathy’? Are there hints here of persisting atavistic habituation: ‘coeliac disease is an intrinsic disorder of jejunum’? Mucosal involvement reflects regional exposure—jejunum, ileum or rectum,4 predicated on intestinal (mesenteric) immune system physiology.

This gives: ‘… a life-long, genetically-determined syndrome caused by gluten ingestion, eliciting a spectrum of (duodenal/jejunal) mucosal changes, and giving rise to symptoms …

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