Coeliac disease/other gastrointestinal diseases

Coeliac disease, also called gluten-sensitive enteropathy or non-tropical sprue, is a disorder primarily affecting the gastrointestinal tract and characterized by chronic inflammation of the mucosa. This leads to atrophy of the intestinal villi, malabsorption and protean clinical manifestations that may begin in childhood or adult life.

Symptoms can include abdominal cramping, bloating and distention, and untreated coeliac disease may lead to vitamin and mineral deficiencies, osteoporosis and other problems.

The disease is also strongly associated with the skin disorder dermatitis herpetiformis. Coeliac disease's major genetic risk factors (HLA-DQ2 and HLA-DQ8) and environmental trigger (specific peptides present in wheat, rye and barley) have been identified, and most patients experience complete remission after exclusion of these grains from the diet. There has therefore been considerable scientific progress in understanding this complex disease and in preventing or curing its manifestations via dietary interventions.

Coeliac disease is now widely considered to be a rare disease in the United States. However, recent studies, primarily in Europe but also in the United States, suggest that its prevalence is much higher than previously estimated, raising the concern that the disease is widely under-recognized. The disease is most common in Caucasians, and occurs only occasionally in African blacks and not in Asians (see epidemiology). Some patients with coeliac disease may be at risk of non-Hodgkin's lymphoma, a rare cancer affecting the gastrointestinal tract. However, it is not yet clear what the impact of this observation should be on diagnostic and treatment strategies.

Immunoglobulin A (IgA) deficiency is 10-15 times more common in patients with coeliac disease (CD) than in healthy subjects (prevalence in healthy subjects: 1 in 600-800). IgA-deficient patients with CD may therefore yield false-negative serology when only IgA isotypes are measured in serodiagnosis.