Coeliac disease: A review

Abstract

Coeliac disease (CD) is a permanent intestinal intolerance to the dietary wheat gliadin and related proteins that produces intestinal villous atrophy in genetically susceptible individuals. Clinical features of CD differ considerably depending on the age at presentation. Intestinal symptoms and failure toi thrive are common in children diagnosed within the first years of life. Presentation of the disease later in childhood is characterized by the prevalence of extraintestinal symptons. Among extraintestinal symptoms, short stature, delayed puberty, anemia, enamel hypoplasia, osteopenia, bilateral occipital calcifications, etc. are related to the presence of gluten in the diet. Family studies demonstrated that CD may also be clinically silent and it is now becoming clear that a great proportion of individuals has a latent form of gluten sensitivity with apparently normal small intestinal mucosa despite exposure to normal amounts of gluten. The most serious potential complication from long-standing CD is malignancy. The risk of developing a small intestinal lymphoma is increased only in patients on a reduced gluten or normal diet. A strict gluten-free diet has become the cornerstone of the management of CD patients and must be recommended for life in both, symptomatic and asymptomatic individuals.