BMJ  2007;335:558-562 (15 September), doi:10.1136/bmj.39316.442338.AD

Clinical Review

Clinical review

Adult coeliac disease

¹ Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield S10 2JF, ² Department of Neurology, Royal Hallamshire Hospital, ³ Studholme Medical Centre, Ashford TW15 2TU

The first 150 words of the full text of this article appear below.

Summary points • The prevalence of coeliac disease is 0.5-1% in international population studies • A combination of tissue transglutaminase antibody, endomysial antibody, and immunoglobulin A should be used for initial testing • Antibody negative coeliac disease with villous atrophy is now recognised • Treatment should involve a gluten-free diet, with support from a dietitian and a gastroenterologist

The prevalence of coeliac disease is 0.5-1% in international population studies. The delay in diagnosis is reported to range from 4.5 years to 9.0 years.^{1 2} Patients may present on numerous occasions to both primary and secondary care without coeliac disease being considered.³ Currently, for every adult patient in whom the disease is diagnosed, eight cases are estimated to go undetected.⁴

What is coeliac disease and why is it more common now?

Coeliac disease (or gluten sensitive enteropathy) is defined as a state of heightened immunological responsiveness to ingested gluten (from wheat, barley, or rye) in genetically susceptible individuals. Coeliac disease has historically been considered to . . . [Full text of this article]

Symptoms in patients presenting with coeliac disease*
Gastrointestinal presenting symptoms
Non-gastrointestinal symptoms

Diagnosis

What serological tests should be performed?
What are the pitfalls in duodenal biopsy and what is antibody negative coeliac disease?

What are the risks for people with coeliac disease?

Who should be tested and what are the unresolved controversies?

Management

Conclusion

Sources and selection criteria
Ongoing research
Unanswered clinical research questions
Tips for non-specialists
Additional educational resources
Resources for healthcare professionals
Resources for patients
A patient's perspective

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This article has been cited by other articles:

• Cooper, M. S, Gittoes, N. J L (2008). Diagnosis and management of hypocalcaemia. BMJ 336: 1298-1302 [Full text]  
• Hepburn, A. L (2007). Rheumatic presentations are common. BMJ 335: 627-627 [Full text]  

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