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Coeliac disease 

Coeliac disease
Chapter:
Coeliac disease
Author(s):

Peter D. Mooney

, and David S. Sanders

DOI:
10.1093/med/9780198746690.003.0300
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date: 05 March 2021

Coeliac disease is a common disorder of the small intestine in which storage proteins in dietary wheat, rye, and barley (gliadin, secalins, and hordeins, usually referred to as ‘gluten’) induce an autoimmune enteropathy characterized by villous atrophy in genetically susceptible individuals. The prevalence of coeliac disease is 0.2 to 2% in populations with high consumption of gluten-containing foods. Females are more commonly affected than males (1.5–2:1), with typical presentation now in the forties. ‘Classical’ coeliac disease presented in childhood with malabsorption, but this is now rare. ‘Nonclassical’ presentations are now the norm, and highly variable, ranging from nonspecific abdominal symptoms to the consequences of malabsorption (e.g. anaemia, osteoporosis) to nongastrointestinal symptoms (e.g. ataxia, dermatitis herpetiformis), and many have no symptoms at all. Diagnosis is made by serological testing for (usually) antitissue transglutaminase antibodies, which have excellent sensitivity and specificity, with confirmation by duodenal biopsy. Treatment is with a gluten-free diet, which constitutes a major challenge for some people. Most patients (but not all) can eat pure oats. Complications include lymphoma, osteoporosis, and other autoimmune conditions. Patients have a normal life expectancy, although quality of life is adversely affected.

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