Introduction In a population-based screening study, adults with undetected coeliac disease had an increased risk of mild anaemia and osteoporosis though they did not regard themselves as being unwell in comparison to serological negative controls.1 While a recent randomised trial reported some benefits from gluten withdrawal in adults with mild enteropathy coeliac disease,2 the benefits and possible harm of early detection of mild enteropathy disease is not clear and only limited data exist on the occurrence and clinical features at diagnosis of this group. We compared the presenting features of coeliacs presenting with mild (Marsh 1, 2) vs severe (Marsh 3) enteropathy disease.

Methods Consecutive incident cases of coeliac disease diagnosed between January 2000–December 2006 at Nottingham University Hospital and Royal Hallamshire Hospital were compared at diagnosis using χ² tests and following 12 months gluten-free diet (GFD) using paired t-tests.

Results Of 724 coeliacs diagnosed during the study period, 51(7%) had mild enteropathy. Mean (SD) haemoglobin (13.9 (1.6) g/dl), ferritin (67.7 (53.2) μg/l), folate (11.0 (5.9) μg/l), B12 (415 (204.9) ng/l), albumin (40.9 (3.1) g/l) and cholesterol (4.6 (1.0) mmol/l) in coeliacs with mild enteropathy were within normal laboratory range and significantly higher than those with severe enteropathy disease. These measures did not change on exposure to a GFD in mild enteropathy disease while the expected beneficial improvements that were observed in severe enteropathy disease. Coeliacs with severe enteropathy had a 10-fold increased risk (OR 10.2, 95% CI 4.4 to 23.4) of presenting with iron deficiency anaemia (IDA) in comparison to those with mild enteropathy whereas there was no difference in odds of presenting with classic (such as weight loss) or non-classic features (such as irritable bowel like symptoms) between mild and severe enteropathy coeliac disease. There was no difference in age at diagnosis of coeliac disease or gender proportion between mild and severe enteropathy groups. Proportion of coeliacs that were EMA positive was lower in mild enteropathy (71% vs 92% in severe enteropathy, p<0.05) disease with median tTG (iu) also lower in mild enteropathy (18.5 (IQR 6–300) vs 210.5 (IQR 43–300) in severe enteropathy, p<0.05).

Conclusion Coeliacs with mild enteropathy have few biochemical deficiencies at diagnosis of coeliac disease and show no important biochemical improvements following GFD treatment in comparison to those with severe enteropathy. Aside from the presence of IDA neither demographic nor presenting symptoms differed between the two groups.