Recent developments in celiac disease.
Celiac disease is a common disorder associated with a substantially increased standardized mortality ratio if it is left untreated or if the diagnosis is delayed. Diagnostic sensitivity of serologic testing is improved by the addition of IgG-based testing to standard IgA-based serologic testing for endomysial or transglutaminase autoantibodies. The role of intestinal permeability testing as an additional tool for screening and for monitoring the response to a gluten-free diet is discussed. The importance of diagnosing celiac disease in two clinical situations is considered: first, before immune-stimulating therapy with interferon for viral hepatitis is begun and second, in pregnancy when not only maternal but also paternal celiac disease may affect fetal outcome. The strong genetic component of the etiology of celiac disease is illustrated by a monozygotic twin concordance of nearly 90%, with susceptibility conveyed by human leukocyte antigen (HLA) genotypes DQ2 or DQ8 and one or more non-HLA genes. Progress toward identifying these genes from large linkage and association studies is reviewed.
Moodie
Simon
S
Department of Gastroenterology (GKT), The Rayne Institute, St. Thomas' Hospital, London, United Kingdom.
Ciclitira
Paul
P