Opinion Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2020; 26(1): 1-10
Published online Jan 7, 2020. doi: 10.3748/wjg.v26.i1.1
Diagnosing coeliac disease: Out with the old and in with the new?
Richard PG Charlesworth
Richard PG Charlesworth, School of Science and Technology, University of New England, Armidale 2351, Australia
Author contributions: Charlesworth RPG designed and wrote the manuscript.
Conflict-of-interest statement: The author has no financial, professional, or personal conflicts of interest relevant to the manuscript to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Richard PG Charlesworth, PhD, Lecturer, School of Science and Technology, University of New England, McClymont Building, Armidale 2350, Australia. rcharle3@une.edu.au
Received: October 17, 2019
Peer-review started: October 17, 2019
First decision: December 4, 2019
Revised: December 5, 2019
Accepted: December 23, 2019
Article in press: December 23, 2019
Published online: January 7, 2020

Coeliac disease (CD) is a complex condition resulting from an interplay between genetic and environmental factors. When diagnosing the condition, serological testing and genotyping are useful in excluding CD, although the gold standard of testing is currently histopathological examination of the small intestine. There are drawbacks associated with this form of testing however and because of this, novel forms of testing are currently under investigation. Before we develop completely novel tests though, it is important to ask whether or not we can simply use the data we gather from coeliac patients more effectively and build a more accurate snapshot of CD through statistical analysis of combined metrics. It is clear that not one single test can accurately diagnose CD and it is also clear that CD patients can no longer be defined by discrete classifications, the continuum of patient presentation needs to be recognised and correctly captured to improve diagnostic accuracy. This review will discuss the current diagnostics for CD and then outline novel diagnostics under investigation for the condition. Finally, improvements to current protocols will be discussed with the need for a holistic “snapshot” of CD using a number of metrics simultaneously.

Keywords: Coeliac disease, Diagnostics, Histology, Serology, Microbiome, Metabolome

Core tip: Due to the complexity of the condition, the diagnosis of coeliac disease can pose unique challenges. This review will discuss the current diagnostics for the condition and then outline novel diagnostics currently under investigation. Finally improvements to the current testing protocols will be discussed with the need for a holistic “snapshot” of the condition, using a number of metrics simultaneously.