[Diagnosis and treatment of celiac disease--what is the status in 1990?]

Summarizing the development of experiences and discussions of the last 20 years, a working group of the ESPGAN has recently updated the criteria of diagnosis of coeliac disease. The reliable finding of the initial typical mucosal lesion in the untreated patient is a hallmark of the disease and, if followed by an unequivocal clinical response to a gluten free diet, can be considered as final evidence for the diagnosis. Gluten challenges should be limited to cases without this evidence. High levels of antigliadin- and antireticulin- or or antiendomysium antibodies are supportive for the diagnosis but cannot substitute biopsy proof of the disease. The importance of a very long term strict gluten free diet in coeliac disease is established by recent evidence showing that in such cases there is no increased risk of malignancy.