What can we do to promote the recognition of celiac disease: a report on diagnostic strategies.
Searching for risk groups with celiac disease is an interdisciplinary problem, and therefore it requires the co-operation of all branches of medicine. It has been suggested that the determination of antiendomysial antibody (AEA) and tissue transglutaminase (t-TG) should be performed by doctors in the first-contact medical facilities. In diagnosed patients, and especially in paediatric practice, it the values of autoantibodies regarding the adherence to a gluten-free diet should be monitored. After reaching the adulthood, patients should be entrusted to the care of gastroenterologists. Biopsy of duodenum samples remains the golden standard for the diagnosis of celiac disease. Every histological examination of a duodenum sample must be completed by histological grading in accordance to Marsh-Oberhuber. Histochemical investigation should be an inseparable part of the malabsorption diagnostics in biopsy. In controversial biopsies, such as a biopsy with minimal or mild pathological changes, application of antibodies to the intraepithelial lymphocytes is recommended. It is also useful to perform electron-microscopy of duodenum samples as well, when repeated biopsies are negative, but the patient's troubles persist (Ref. 32).
Makovicky
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P
Czech University of Life Sciences, Prague, Czech Republic. pmakovicky@email.cz
D000328:Adult; D001707:Biopsy, Needle; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy / Q000473:pathology; D006801:Humans; D007421:Intestine, Small / Q000473:pathology