Reviews and feature article
Celiac disease

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This review will focus on the pathogenesis, clinical manifestations, diagnosis, and management of celiac disease (CD). Given an increasing awareness of gluten-related disorders, medical professionals of all varieties are encountering patients with a diagnosis of CD or who are thought to have food intolerance to gluten. The prevalence of CD among the general population is estimated to be 1% in Western nations, and there is growing evidence for underdiagnosis of the disease, especially in non-Western nations that were traditionally believed to be unaffected. The development of serologic markers specific to CD has revolutionized the ability both to diagnose and monitor patients with the disease. Additionally, understanding of the clinical presentations of CD has undergone a major shift over the past half century. Although it is well understood that CD develops in genetically predisposed subjects exposed to gluten, the extent of other environmental factors in the pathogenesis of the disease is an area of continued research. Currently, the main therapeutic intervention for CD is a gluten-free diet; however, novel nondietary agents are under active investigation. Future areas of research should also help us understand the relationship of CD to other gluten-related disorders.

Section snippets

Epidemiology

CD was once considered a rare condition characterized predominately by intestinal symptoms that led to a malabsorption syndrome and stunted growth in young children of European ancestry. However, it is now appreciated that CD has a worldwide and increasing incidence among persons of various ethnic groups and among both adults and children.15, 16, 17, 18

Numerous studies in which serologic screening was performed among the general population indicate that CD has a prevalence of nearly 1% among

Conclusions

Over the decades since the initial description of CD, there has been a major increase in the awareness of the disease among the general population. Although generally underdiagnosed, CD appears to have an increasing prevalence worldwide. The introduction of wheat-based products into societies throughout the globe might contribute to the trend; however, other environmental factors that allow for patients with a predisposing genetic background to have the disease are only partially understood.

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