Celiac disease: diagnostic criteria in progress.

Area of Science:

• Immunology
• Gastroenterology
• Autoimmune Disorders

Background:

• Celiac disease (CD) was historically viewed as a rare childhood intolerance with severe malabsorption.
• Current understanding recognizes CD as a common autoimmune disorder (1 in 100 individuals) with varied presentations and adult onset.
• Diagnosis is complex due to diverse gastrointestinal and extra-intestinal symptoms, including asymptomatic cases.

Purpose of the Study:

• To highlight the evolving understanding of celiac disease (CD) beyond severe malabsorption.
• To emphasize the role of advanced serological tests in diagnosing CD.
• To discuss the spectrum of CD, including potential and early-stage cases.

Main Methods:

• Review of diagnostic advancements in celiac disease (CD) over the past 20 years.
• Focus on the increasing accuracy of serological tests, including IgA tissue transglutaminase, antiendomysial, and IgG antideamidated gliadin peptide antibodies.
• Inclusion of HLA-DQ2 and HLA-DQ8 testing for complex cases.

Main Results:

• Highly reliable antibody markers have significantly improved CD diagnostic accuracy.
• Discovery of numerous 'potential CD' cases with positive serology and mild or absent intestinal lesions.
• Recognition that serology may identify CD before severe intestinal damage occurs.

Conclusions:

• The spectrum of celiac disease (CD) is broader than previously thought, encompassing mild and early-stage presentations.
• Serological testing is crucial for identifying potential CD and cases in early development.
• HLA typing can aid in diagnosing gluten sensitivity in cases with equivocal serology and intestinal findings.