title: Clinical practice : coeliac disease.
abstract: Coeliac disease (CD) is an immune-mediated systemic condition elicited by gluten and related prolamines in genetically predisposed individuals and characterised by gluten-induced symptoms and signs, specific antibodies, a specific human leukocyte antigen (HLA) type and enteropathy. The risk of coeliac disease is increased in first-degree relatives, certain syndromes including Down syndrome and autoimmune disorders. It is thought to occur in 1 in 100-200 individuals, but still only one in four cases is diagnosed. Small-bowel biopsy is no longer deemed necessary in a subgroup of patients, i.e. when all of the following are present: typical symptoms or signs, high titres of and transglutaminase antibodies, endomysial antibodies, and HLA-type DQ2 or DQ8. In all other cases, small-bowel biopsy remains mandatory for a correct diagnosis. Therapy consists of a strictly gluten-free diet. This should result in complete disappearance of symptoms and of serological markers. Adequate follow-up is considered essential.
  
  
  CONCLUSIONS
  Although small-bowel biopsy may be omitted in a minority of patients, small-bowel biopsy is essential for a correct diagnosis of CD in all other cases. Diagnostic work-up should be completed before treatment with gluten-free diet instituted.
authors.affiliation: Department of Paediatrics, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. cmf.kneepkens@vumc.nl
authors.forename: C M Frank
authors.initials: CM
authors.lastname: Kneepkens
authors.forename: B Mary E
authors.initials: BM
authors.lastname: von Blomberg
mesh_terms: D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis / Q000178:diet therapy / Q000453:epidemiology / Q000503:physiopathology; D055050:Diet, Gluten-Free; D006801:Humans; D015994:Incidence; D007421:Intestine, Small / Q000473:pathology; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis