title: Coeliac disease--a diagnostic and therapeutic challenge.
abstract: During the past 20 years the diagnosis of coeliac disease has improved significantly. However, at the same time the true prevalence of the condition has doubled, involving more than 2% of the population in some countries. Due to mild or atypical symptoms, the diagnosis remains a challenge for the health care system. Highly sensitive and specific serum endomysial and transglutaminase-2 antibody tests are helpful in identifying patients for diagnostic endoscopy and small-bowel biopsy. The diagnosis of the disease is still based on the demonstration of gluten-induced small-bowel mucosal villous atrophy with crypt hyperplasia. However, coeliac disease may manifest itself before the development of the overt small-intestinal lesion. Positive endomysial and transglutaminase antibodies in patients with normal small-bowel mucosal villous architecture may indicate early stage coeliac disease. Currently, the only effective treatment for the condition is a life-long strict gluten-free diet. Long-term regular follow-up of patients is recommended in order to maintain good adherence to the diet.
authors.affiliation: Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland. katri.kaukinen@uta.fi
authors.forename: Katri
authors.initials: K
authors.lastname: Kaukinen
authors.forename: Katri
authors.initials: K
authors.lastname: Lindfors
authors.forename: Pekka
authors.initials: P
authors.lastname: Collin
authors.forename: Outi
authors.initials: O
authors.lastname: Koskinen
authors.forename: Markku
authors.initials: M
authors.lastname: Mäki
mesh_terms: D000818:Animals; D002446:Celiac Disease / Q000175:diagnosis* / Q000209:etiology / Q000235:genetics / Q000628:therapy*; D006801:Humans; D015995:Prevalence