Coeliac disease: current approach and future prospects
Public anxiety over gluten has fuelled widespread demand for gluten‐free food, yet coeliac disease remains significantly underdiagnosed and some confusion remains regarding optimal diagnostic practices. Small bowel histology is the gold standard for diagnosis. High‐quality commercial enzyme‐linked i...
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Published in | Internal medicine journal Vol. 38; no. 10; pp. 790 - 799 |
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Main Author | |
Format | Journal Article |
Language | English |
Published |
Melbourne, Australia
Blackwell Publishing Asia
01.10.2008
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Subjects | |
Online Access | Get full text |
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Summary: | Public anxiety over gluten has fuelled widespread demand for gluten‐free food, yet coeliac disease remains significantly underdiagnosed and some confusion remains regarding optimal diagnostic practices. Small bowel histology is the gold standard for diagnosis. High‐quality commercial enzyme‐linked immunosorbent assays for transglutaminase immunoglobulin A and deamidated gliadin immunoglobulin A and G are sensitive tools for screening, but almost 10% of coeliac disease is seronegative and serological testing is unreliable in the very young, in people already following a gluten‐reduced diet, and those using immunosuppressive medications. HLA DQA and DQB genotyping to show that alleles encoding HLA DQ2 and DQ8 are absent virtually excludes coeliac disease. Confirming histological remission reduces the risks of later complications, such as osteoporosis and cancer. Monitoring remission by serology is unreliable. Because gluten is an exogenous antigen and the small intestine is readily accessible, the immunopathogenesis of coeliac disease is better understood than other strongly major histocompatibility complex class II‐associated diseases, such as type 1 diabetes mellitus. Therapeutic targets have been identified and drugs are under development to supplement or even replace gluten‐free diet. With greater awareness and non‐dietary therapeutics, diagnosis and treatment of coeliac disease will be increasingly prominent in medical practice. |
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Bibliography: | istex:DB404B7AD3AC1AC6A5CAE2BD11CEC4FD6F071468 ArticleID:IMJ1741 ark:/67375/WNG-V6TCJPTH-4 Funding: WEHI‐Melbourne Health Ian Mackay Fellowship, NHMRC, Nexpep Pty Ltd. Potential conflicts of interest: The author is inventor of patents relating to diagnostics, therapeutics and non‐toxic gluten based on knowledge of peptides recognized by T cells in coeliac disease. The author is also involved in the commercialization of these patents as Director, Chief Scientist and Chief Medical Officer and is substantial shareholder in Nexpep Pty Ltd and Nexgrain Pty Ltd. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-3 ObjectType-Review-1 |
ISSN: | 1444-0903 1445-5994 |
DOI: | 10.1111/j.1445-5994.2008.01741.x |