title: Advances in diagnosis and management of celiac disease.
abstract: Celiac disease is an autoimmune disorder that is induced by dietary gluten in genetically predisposed individuals. It has a prevalence of approximately 1% in many populations worldwide. New diagnoses have increased substantially, owing to increased awareness, better diagnostic tools, and probable real increases in incidence. The breadth of recognized clinical presentations continues to expand, making the disorder highly relevant to all physicians. Newer diagnostic tools, including serologic tests for antibodies against tissue transglutaminase and deamidated gliadin peptide, greatly facilitate diagnosis. Tests for celiac-permissive HLA-DQ2 and HLA-DQ8 molecules are useful in defined clinical situations. Celiac disease is diagnosed by histopathologic examination of duodenal biopsy specimens. However, according to recent controversial guidelines, a diagnosis can be made without a biopsy in certain circumstances, especially in children. Symptoms, mortality, and risk for malignancy each can be reduced by adherence to a gluten-free diet. This treatment is a challenge, however, because the diet is expensive, socially isolating, and not always effective in controlling symptoms or intestinal damage. Hence, there is increasing interest in developing nondietary therapies.
authors: Celiac Program, Harvard Medical School and Department of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Electronic address: ckelly2@bidmc.harvard.edu.
authors: Ciarán P
authors: CP
authors: Kelly
authors: Hospital Gastroenterologia, and Department of Gastroenterology, School of Medicine, Universidad del Salvador, Buenos Aires, Argentina.
authors: Julio C
authors: JC
authors: Bai
authors: Colorado Center for Celiac Disease, Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado; Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors: Edwin
authors: E
authors: Liu
authors: Celiac Program, Harvard Medical School and Department of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors: Daniel A
authors: DA
authors: Leffler
mesh_terms: D000818:Animals; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy* / Q000235:genetics / Q000276:immunology; D055050:Diet, Gluten-Free; D005819:Genetic Markers; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D006683:HLA-DQ Antigens / Q000235:genetics / Q000276:immunology; D006801:Humans; D010641:Phenotype; D011237:Predictive Value of Tests; D012307:Risk Factors; D012698:Serologic Tests; D016896:Treatment Outcome
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D005819:Genetic Markers; D006683:HLA-DQ Antigens; C053186:HLA-DQ2 antigen; C109756:HLA-DQ8 antigen
keywords: Autoimmune; Cereal; Diet; Enteritis; Enteropathy; Gluten; Gluten-Free Diet; Lymphoma; Malabsorption; Nutritional Deficiency; Refractory; Serology; Villous Atrophy; Wheat