Coeliac disease

Coeliac disease is a common condition that affects as many as 1 in 100 Caucasians and may present at any age after weaning with a spectrum of symptoms ranging from none to all, through mild irritable bowel type complaints, to weight loss and diarrhoea. Patients with coeliac disease are at increased risk of autoimmunity. The majority of patients express either HLA DQ2 or DQ8 haplotypes, but it is likely that a large number of genes (some of which have recently been identified) are implicated in disease expression. IgA antibodies against tissue transglutaminase have a high specificity but sensitivity as low as 80% for detection of the condition and intestinal biopsy remains the diagnostic standard. Treatment with a strict gluten-free diet is mandatory and leads to a reduced risk of associated complications that include low bone mineral density and intestinal malignancy. The majority of patients thought to be ‘refractory’ to dietary treatment are found to have gluten sources in the diet, but a small proportion harbour atypical monoclonal intraepithelial lymphocytes and are at risk of developing intestinal lymphoma. Non-dietary treatments are currently under investigation.