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.

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 …