[Celiac disease in adults: new aspects]

Area of Science:

• Gastroenterology and Immunology
• Autoimmune Disorders
• Nutritional Science

Context:

• Celiac disease (gluten-sensitive enteropathy) is an autoimmune disorder triggered by gluten ingestion in genetically susceptible individuals.
• The clinical presentation of adult celiac disease has evolved, with extraintestinal manifestations now common.
• Recent advances include identifying latent/silent celiac sprue and understanding its association with HLA class II molecules and tissue transglutaminase.

Purpose:

• To highlight the changing spectrum of adult celiac disease and the importance of updated diagnostic approaches.
• To emphasize the role of serological markers, such as anti-tissue transglutaminase antibodies, in celiac disease diagnosis.
• To advocate for systematic screening in at-risk populations and those with atypical symptoms.

Summary:

• Celiac disease involves small intestinal mucosal atrophy due to gluten, with lifelong gluten avoidance as the only treatment.
• Atypical presentations and silent/latent forms have historically led to underdiagnosis, increasing risks of deficiencies and malignancy.
• New serological tests, particularly anti-tissue transglutaminase antibody assays, offer efficient screening and diagnosis.

Impact:

• Improved diagnostic strategies can lead to earlier detection of celiac disease, mitigating long-term health risks.
• Increased awareness of atypical presentations will encourage screening in broader patient groups.
• The advent of reliable serological tests promises to enhance the efficiency and accuracy of celiac disease diagnosis in clinical practice.