[Celiac disease (gluten sensitive enteropathy)]

The frequency in the Austrian population of coeliac disease is approximately 1 in 1000 live births. The diagnosis is easy in most cases, if not obscured by an inconsiderate and inconsequent approach. The most frequent mistake is prescribing gluten free diet on trial before proving the diagnosis by small bowel biopsy. Failure to thrive, deficiency states and abnormal stools are the leading symptoms of coeliac disease. Careful inquiries and drawing of curves for length and weight usually give more information than expensive laboratory tests. Symptoms are frequently equivocal in relapses, in older children, and especially in adults. The basic prerequisite for the diagnosis of coeliac disease is the finding of subtotal villous atrophy in the small bowel mucosa. The only absolute contraindication against small bowel suction biopsy is a blood clotting defect. The small inconvenience from this procedure can be further reduced by experience and discipline of the examiner. Small bowel biopsies are performed in many paediatric hospitals. Thus, there is no excuse for omitting or delaying this procedure. Antigliadin antibodies and antiendomysial antibodies are of high diagnostic significance. The respective IgA antibodies show a high specificity, IgG antibodies a very high sensitivity. Thus, the decision for or against small bowel biopsy is made easier in doubtful cases, the evidence by villous atrophy for coeliac disease is approaching absolute proof. Gluten loading tests and multiple biopsies are therefore necessary only in rare cases. The very high frequency of certain HLA alleles in coeliac patients may also be used for diagnostic purposes. The pathogenesis of coeliac disease appears to involve genetic, immunologic, and environmental factors. The contribution of each of these factors may vary considerably in various patients.