Shaare Zedek Medical Center, Jerusalem, Israel
During the last
decade significant changes have occurred in our understanding of celiac
disease. Due to the implementation of sensitive and specific serological tests,
as well as screening of asymptomatic populations, the epidemiology and clinical
presentation of affected subjects have been significantly reconsidered.
Extraintestinal manifestations of celiac disease have been increasingly
recognized and the association with autoimmune disorders is well established.
The disease is a valuable model for clinicians and scientists as it represents
an interplay between genetic, immunologic and environmental factors.
It is clear that
the specific DQ alleles are not the only genetic markers for celiac disease.
Also, it is postulated that upon screening asymptomatic populations the actual
incidence of celiac disease will be in the proximity of 1:100.
One should stress
that although the serological markers are very sensitive and specific, small
bowel biopsy is still a pivotal requirement for the ultimate diagnosis of
celiac disease. On the other hand, mucosal atrophy by itself can be caused by
entities other than celiac disease.
The treatment by
gluten-free diet is crucial not only for normal growth and well being but also
for reducing development of malignant disorders mainly non-Hodgkin lymphoma.