Clinical Review Clinical review

Adult coeliac disease

BMJ 2007; 335 doi: http://dx.doi.org/10.1136/bmj.39316.442338.AD (Published 13 September 2007) Cite this as: BMJ 2007;335:558
  1. Andrew D Hopper, gastroenterology specialist registrar1,
  2. Marios Hadjivassiliou, consultant neurologist2,
  3. Sohail Butt, general practitioner3,
  4. David S Sanders, consultant gastroenterologist1
  1. 1Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield S10 2JF
  2. 2Department of Neurology, Royal Hallamshire Hospital
  3. 3Studholme Medical Centre, Ashford TW15 2TU
  1. Correspondence to: A D Hopper, Room P39, P Floor, Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield S10 2JF.andydhopper{at}aol.com

    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 be an uncommon gastrointestinal condition. In addition, most clinicians expect to recognise infant or childhood presentations with overt symptoms of malabsorption (or failure to thrive).

    A paradigm shift has occurred, however, in our conceptual understanding of coeliac disease. Recent international studies assessing the prevalence of coeliac disease in the general population have consistently reported that coeliac disease affects 0.5-1% of all adults.w1 Adult presentations are now more frequent than paediatric (a ratio of 9:1, according to the 2005 membership data of the Coeliac UK charity). Patients most commonly present during their 40s.w2

    Patients with adult coeliac disease rarely present with symptoms suggestive of malabsorption (low body mass index accounts for 5% of all cases diagnosed, with most having either a normal or overweight body mass indexw3). Far more commonly they describe non-specific or subtle gastrointestinal symptoms (for example, non-specific abdominal pain, symptoms similar …

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