Celiac Disease: Diagnostic dilemma

Celiac disease, an autoimmune disorder, occurs in genetically susceptible individuals and is triggered by the ingestion of well identified autoantigen- gluten. It affects primarily the small intestine, where it progressively leads to flattening of small intestinal mucosa. Three cereals contain gluten and are toxic for Celiac patients – wheat, rye and barley. It occurs more commonly in relatives of celiac patients and some at risk groups. It causes gastrointestinal symptoms, predominantly chronic diarrhoea with wasting, but also many extra-intestinal manifestations can be present alone. Suspected patient should be screened with transglutaminase + total serum IgA and if positive, confirmed by biopsy before the gluten free diet is started. A gluten free diet typically reverses all signs and symptoms within a short time. Monitoring of the patient to verify ongoing dietetic compliance is fundamental in order to ensure that all possible complications, including malignancies, are avoided.

Author(s): Bharat J Parmar

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