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Searching for the missing link in coeliac disease

BMJ 2019; 364 doi: (Published 13 February 2019) Cite this as: BMJ 2019;364:l696

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Enterovirus as trigger of coeliac disease

  1. M P Tighe, consultant paediatrician1,
  2. R Mark Beattie, consultant paediatric gastroenterologist2
  1. 1Department of Paediatrics, Poole Hospital NHS Foundation Trust, Poole, UK
  2. 2Child Health, Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton S016 6YD, UK
  1. Correspondence to: R M Beattie mark.beattie{at}

Finding a viral trigger would help to target screening in children at high risk

Since the identification of gluten as the dietary trigger for coeliac disease in the Netherlands after the second world war, people have speculated about a “missing link” that could trigger active disease in genetically predisposed individuals who are exposed to gluten. Genetic predisposition to coeliac disease is conferred by two commonly occurring HLA variants: DQ2 and DQ8.1

Coeliac disease can present at any age. Although a historical peak in incidence occurred among children aged under 2 years, more recent data suggest that the median age of diagnosis is now 5 years (incidence 0.8-1.6/10 000), with another peak in incidence in adults in their 50s (2.3/1000).23

Coeliac disease is diagnosed using a combination of serology and duodenal biopsy.4 Importantly, negative testing for coeliac disease does not rule out the possibility of the disease developing later. Regular screening has a role in groups at high risk, including children with Down’s syndrome or …

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