Clinical Review Fortnightly review

Coeliac disease

BMJ 1999; 319 doi: http://dx.doi.org/10.1136/bmj.319.7204.236 (Published 24 July 1999) Cite this as: BMJ 1999;319:236
  1. Conleth Feighery, professor (con.feighery@tcd.ie)
  1. Department of Immunology, St James's Hospital, Dublin 8, Ireland
  • Accepted 6 May 1999

Coeliac disease is an inflammatory disease of the upper small intestine and results from gluten ingestion in genetically susceptible individuals.1 2 Inflammation may lead to the malabsorption of several important nutrients. Clinical and mucosal recovery after institution of a gluten free diet is objective evidence that the enteropathy is gluten induced. In 1950, Dicke observed the central role of gluten in the pathogenesis of coeliac disease.3 Coeliac disease is closely related to dermatitis herpetiformis.4 In dermatitis herpetiformis, skin rash and a similar small intestinal enteropathy to that of coeliac disease are typically present, and both respond to withdrawal of gluten.

Summary points

In coeliac disease, dietary gluten causes inflammation of the small intestine, which may affect absorption of important nutrients including iron, folic acid, calcium, and fat soluble vitamins

Studies show coeliac disease to be a common disorder, possibly affecting 1 in 200 of the general population, the majority of patients being diagnosed in adulthood

Many patients have minimal symptoms, and gastrointestinal symptoms are frequently absent

Coeliac disease should be considered in a wide range of clinical situations including anaemia or osteoporosis and in patients with a range of associated disorders such as type 1 diabetes

The diagnosis and screening for coeliac disease has been facilitated by testing for endomysial autoantibodies

Treatment consists of permanent withdrawal of gluten from the diet, which results in complete remission

Methods

My review is based on the proceedings of regular international symposiums57 and meetings8 on coeliac disease, textbooks,1 2 review articles,9 and searches of Medline (250 articles were published in 1997 alone).

Symptoms and signs

A range of symptoms and signs may be associated with untreated coeliac disease, and these can be divided into intestinal features and those caused by malabsorption1 2 9 (box 1). It should be emphasised, however, …

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