Coeliac disease

Coeliac disease is a common condition that may present at any age after weaning with a spectrum of symptoms ranging from none at all, through mild irritable bowel type complaints, to weight loss and diarrhoea. Patients with coeliac disease have an increased risk of autoimmunity. The majority of patients express either HLA DQ2 or 8 haplotypes, but other genetic factors required for disease expression remain undiscovered. IgA antibodies against tissue transglutaminase have a high specificity but a 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.