Follow up and review are needed when test results are not clear

Two articles in this issue remind us about coeliac disease and the need to consider it as a diagnosis in seemingly unusual circumstances—in elderly patients and in obese patients (p 773, 775).1 2 Furthermore, in the patient reported by Saunders et al, the usual diagnostic features of anti-endomysial and anti-transglutaminase antibodies and histological enteropathy were absent initially.1

Coeliac disease is a relatively common condition. Its prevalence is approximately 0.3-1% of the population in almost all countries and ethnic groups where it has been investigated.3 Previously regarded largely as a childhood problem it is now recognised to affect mostly adults, with about 25% of patients receiving their diagnosis at over 60 years of age.4 When present, the features of malabsorption (diarrhoea and weight loss) should point to the diagnosis, but now a wide range of clinical manifestations are recognised. Patients often have few or no gastrointestinal symptoms and can even be obese.2 5

Conventionally diagnosis is based on the histological finding of …