The diagnosis and treatment of celiac disease

Dtsch Arztebl Int. 2013 Dec 6;110(49):835-46. doi: 10.3238/arztebl.2013.0835.

Abstract

Background: Celiac disease is an inflammatory disease of, the small intestine with a prevalence of roughly 0.5%-1%. Its symptoms arise in response to gluten consumption by genetically predisposed persons (HLA-DQ2/8). The autoantigen tissue transglutaminase (TG2) plays an important role in the pathogenesis of celiac disease.

Method: Selective review of pertinent literature, including guidelines from Germany and abroad.

Results: Celiac disease can present at any age with gastrointestinal or extraintestinal manifestations (e.g., malabsorption or Duhring's dermatitis herpetiformis); it can also be found in association with other (auto-)immune diseases, such as type 1 diabetes. Most cases are oligosymptomatic. The wide differential diagnosis includes food intolerances, intestinal infections, and irritable bowel syndrome, among other conditions. The definitive diagnosis requires the demonstration of celiac disease-specific autoantibody to TG2 (endomysium), which is over 90% sensitive and far over 90% specific, and the characteristic histologic lesions of the small-bowel mucosa and remission on a gluten-free diet.

Conclusion: An understanding of celiac disease ought to inform everyday clinical practice in all medical disciplines, because this is a common condition with diverse manifestations that can be effectively diagnosed and easily treated for the prevention of both acute and long-term complications. Patients should follow a strictly gluten-free diet for life.

Publication types

  • Review

MeSH terms

  • Biomarkers / blood
  • Celiac Disease / blood
  • Celiac Disease / diagnosis*
  • Celiac Disease / therapy*
  • Diet, Gluten-Free / methods*
  • Diet, Gluten-Free / standards*
  • Evidence-Based Medicine
  • GTP-Binding Proteins
  • Humans
  • Internationality
  • Practice Guidelines as Topic*
  • Protein Glutamine gamma Glutamyltransferase 2
  • Transglutaminases / blood*

Substances

  • Biomarkers
  • Protein Glutamine gamma Glutamyltransferase 2
  • Transglutaminases
  • GTP-Binding Proteins