[When gastrointestinal symptoms present, consideration should always be given to celiac disease]

Celiac disease/nontropical sprue is diagnosed too rarely and often too late. In the routine clinical setting, therefore, it should receive more consideration. In patients with gastrointestinal symptoms that prompt gastroscopy, a small bowel biopsy should always be obtained, for it alone detects sprue. Despite the high level of accuracy of antibody determination, there is no substitution for the demonstration of atrophic villi in biopsy material. In the absence of a diagnosis, a gluten-free diet should not be recommended, since in patients who actually have the disease, mucosal changes will regress, and confirmation of the diagnosis is no longer possible. Once the diagnosis has been confirmed, treatment comprises a life-long gluten-free diet, which not only leads to an improvement of the symptoms, but also eliminates the increased lymphoma risk.