Editorial
Copyright ©2007 Baishideng Publishing Group Co.
World J Gastroenterol. Feb 28, 2007; 13(8): 1156-1161
Published online Feb 28, 2007. doi: 10.3748/wjg.v13.i8.1156
Table 1 Clinical manifestations of untreated celiac disease
ManifestationsAssociated diseasesGenetic associated diseases
Classic symptoms:Autoimmune diseases:Down syndrome
Turner syndrome
Abdominal painType 1 diabetesWilliam syndrome
AnorexiaThyroiditisIgA deficiency
DiarrheaSjogren’s syndrome
Weight lossIgA nephropathy
Short stature
IrritabilityNeurologic disturbances:
Nonclassic symptoms:Autism
Depression
Dermatitis hepertiformisEpilepsy
HepatitisCerebellar ataxia
Anemia
ArthritisOther diseases:
Constipation
AlopeciaOsteopenia/osteoporosis
Pubertal delayInfertility
VomitingIntestinal adenocarcinoma
Inflammatory bowel diseaseNon-Hodgkin lymphoma
Migraine headaches
Table 2 Diagnosis in celiac disease
Diagnostic criteria used in celiac diseaseDiagnostic propose for celiac diseaseComments
Serological test:With classical symptoms:Positive serology supports a diagnosis of CD, but they are not
Tissue transglutaminase antibody (tTGA)Serological test:essential. Compatible with HLA-DQ2/D8 testing and identify
Endomysial antibody (EMA)Tissue transglutaminase antibody (tTGA)individuals for further biopsy evaluation. Small bowel biopsy
Gliadin antibodies (AGA)Endomysial antibody (EMA)is critical in symptomatic patients with negative serology for
Total IgAGliadin antibodies (AGA)CD and with HLA compatible with the disease
EndoscopyHLA-DQ2/DQ8 testingDetermination of HLA typing as a first step in diagnosis in CD family
Capsule endoscopy (with adequate pathological interpretation)Adequate number of biopsies and well oriented. Estimate lymphocyte infiltration and partial or total villus atrophy
Without classical symptoms HLA-DQ2/DQ8 testingPrimordial role of HLA-typing if serology is negative and with biopsy refused or equivocal to identify individuals
Serologic test:Adequate number of biopsies and well oriented. Estimate
Tissue transglutaminase antibody (tTGA)lymphocyte infiltration and partial or total villous atrophy
Endomysial antibody (EMA)
Gliadin antibodies (AGA)
Capsule endoscopy (with adequate pathological interpretation)
Table 3 Future directions in celiac disease
Unanswered questionsFuture directions
Immunopathogenesis
How is oral tolerance broken?Restoring immunological tolerance to gluten would represent the ideal cure for CD
Gluten-specific T cellsGluten-specific T cells could be inactivated or deleted, tolerance to gluten should be restored
Diagnosis
What is the significance of the vast number of currently undiagnosed people with the disease?The rate of the diagnosis will continue to increase with better diagnosis.
What is the significance of the increase number of people with extraintestinal symptoms or without classical symptoms in CD?“the suspicion of the disease”
Genetics
Identify the genetic risk factors that predispose to CDPolymorphic genes located in the MHC region and CD
Genetic polymorphism of cytokine genes may influence the risk of CD
Associated polymorphism with serological markers
HLA-G polymorphism?