Celiac disease.

As many as one in every 100 to 200 persons in the United States has celiac disease, a condition resulting from an inappropriate immune response to the dietary protein gluten. The manifestations of celiac disease range from no symptoms to overt malabsorption with involvement of multiple organ systems and an increased risk of some malignancies. When celiac disease is suspected, initial testing for serum immunoglobulin A (IgA) tissue transglutaminase (tTG) antibodies is useful because it offers adequate sensitivity and specificity at a reasonable cost. A positive IgA tTG result should prompt small bowel biopsy with at least four tissue samples to confirm the diagnosis. However, 3 percent of patients with celiac disease have IgA deficiency. Therefore, if the serum IgA tTG result is negative but clinical suspicion for the disease is high, a serum total IgA level may be considered. Screening of asymptomatic patients is not recommended. The basis of treatment for celiac disease is adherence to a gluten-free diet, which may eliminate symptoms within a few months. Patients should also be evaluated for osteoporosis, thyroid dysfunction, and deficiencies in folic acid, vitamin B12, fat-soluble vitamins, and iron, and treated appropriately. Serum IgA tTG levels typically decrease as patients maintain a gluten-free diet.

[1]  D. V. van Heel,et al.  Genetics and pathogenesis of coeliac disease. , 2009, Seminars in immunology.

[2]  A. Fasano,et al.  A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease. , 2007, The American journal of clinical nutrition.

[3]  M. Kagnoff AGA Institute Medical Position Statement on the Diagnosis and Management of Celiac Disease. , 2006, Gastroenterology.

[4]  M. Kagnoff,et al.  American Gastroenterological Association (AGA) Institute technical review on the diagnosis and management of celiac disease. , 2006, Gastroenterology.

[5]  N. Lewis,et al.  Systematic review: the use of serology to exclude or diagnose coeliac disease (a comparison of the endomysial and tissue transglutaminase antibody tests) , 2006, Alimentary pharmacology & therapeutics.

[6]  W. Caspary,et al.  Celiac disease , 2006, Orphanet journal of rare diseases.

[7]  Moshe Rubin,et al.  The value of wireless capsule endoscopy in patients with complicated celiac disease. , 2005, Gastrointestinal endoscopy.

[8]  C. Kupper Dietary guidelines and implementation for celiac disease. , 2005, Gastroenterology.

[9]  I. Hill What are the sensitivity and specificity of serologic tests for celiac disease? Do sensitivity and specificity vary in different populations? , 2005, Gastroenterology.

[10]  S. James National Institutes of Health Consensus Development Conference Statement on Celiac Disease, June 28-30, 2004. , 2005, Gastroenterology.

[11]  P. Ciclitira,et al.  Clinical features and diagnosis of celiac disease. , 2005, Gastroenterology.

[12]  Marian Rewers,et al.  Epidemiology of celiac disease: what are the prevalence, incidence, and progression of celiac disease? , 2005, Gastroenterology.

[13]  G. Holmes,et al.  Association of celiac disease and intestinal lymphomas and other cancers. , 2005, Gastroenterology.

[14]  P. Collin Should adults be screened for celiac disease? What are the benefits and harms of screening? , 2005, Gastroenterology.

[15]  P. Green The many faces of celiac disease: clinical presentation of celiac disease in the adult population. , 2005, Gastroenterology.

[16]  E. Seidman,et al.  Guideline for the Diagnosis and Treatment of Celiac Disease in Children : Recommendations of the North American Society for Pediatric Gastroenterology , Hepatology and Nutrition , 2004 .

[17]  W. Treem Emerging concepts in celiac disease , 2004, Current opinion in pediatrics.

[18]  F. Cataldo,et al.  The global village of celiac disease. , 2004, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[19]  G. Tamburlini,et al.  Mass screening for coeliac disease using antihuman transglutaminase antibody assay , 2004, Archives of Disease in Childhood.

[20]  H. Freeman Lymphoproliferative and Intestinal Malignancies in 214 Patients With Biopsy-defined Celiac Disease , 2004, Journal of clinical gastroenterology.

[21]  M. Rewers,et al.  Celiac disease associated with type 1 diabetes mellitus. , 2004, Endocrinology and metabolism clinics of North America.

[22]  A. Neugut,et al.  Risk of malignancy in patients with celiac disease. , 2003, The American journal of medicine.

[23]  J. Murray,et al.  Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. , 2003, Archives of internal medicine.

[24]  K. Kaukinen,et al.  Endocrinological disorders and celiac disease. , 2002, Endocrine reviews.

[25]  L. Greco,et al.  The first large population based twin study of coeliac disease , 2002, Gut.

[26]  D. Sanders,et al.  Changing face of adult coeliac disease: experience of a single university hospital in South Yorkshire , 2002, Postgraduate medical journal.

[27]  A. Fasano,et al.  Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum. , 2001, Gastroenterology.

[28]  G. Oberhuber,et al.  The histopathology of coeliac disease: time for a standardized report scheme for pathologists. , 1999, European journal of gastroenterology & hepatology.

[29]  P. Lionetti,et al.  Coeliac disease in Saharawi children in Algerian refugee camps , 1999, The Lancet.

[30]  G. Corazza,et al.  Prevalence and clinical features of selective immunoglobulin A deficiency in coeliac disease: an Italian multicentre study. Italian Society of Paediatric Gastroenterology and Hepatology (SIGEP) and "Club del Tenue" Working Groups on Coeliac Disease. , 1998, Gut.

[31]  T. Reunala,et al.  Malignancy and survival in dermatitis herpetiformis: a comparison with coeliac disease. , 1996, Gut.

[32]  E. Gudmand-Høyer,et al.  Symptoms and haematologic features in consecutive adult coeliac patients. , 1996, Scandinavian journal of gastroenterology.

[33]  G. Holmes,et al.  Malignancy in coeliac disease--effect of a gluten free diet. , 1989, Gut.