Serology positive in almost 100% if not IgA-deficient
Correlation between sero-sensitivity, endoscopy and Histology Dickey W. Endoscopic markers for celiac disease. Nat Clin Pract Gastroenterol Hepatol. 2006;3:546-51. 31% sensitivity for serology 100% sensitivity for serology
Coeliac disease IgG/IgA -gliadin IgA -tTG/EMA Mucosal biopsy 3-4 samples Gluten Free Diet Childeren < 2 yrs (-> IgG/IgA -gliadin Symptoms but no antibodies =>DQ2/8 and biopsy IgA deficiency (prevalence 2% in CD vs 0.2% in normal population) Gluten Free Diet Repeat biopsy Schuppan et al Dig Liv Dis October 2004;10:358-360
Seropositive with normal histology
Brocchi et al. Adult coeliac disease diagnosed by endoscopic biopsies in the duodenal bulb. Eur J Gastroenterol Hepatol. 2005;17:1413-5.
Villanacci V et al. Histological aspects of the terminal ileum: a windows on coeliac disease too? Dig Liver Dis. 2006;38:820-2.
Entire small bowels
Normal Duodenal biopsy do not exclude diagnosis
Segmental biopsy would be required
Green PH, Rostami K, Marsh MN. Diagnosis of coeliac disease. Best Pract Res Clin Gastroenterol. 2005;19:389-400
If the symptoms persist
Serology does not exclude Diagnosis
Which of the following is the most common reason for failing to respond to a gluten free diet?
A The diagnosis was wrong
B Non-concordance with diet
C Lactose intolerance
D Pancreatic insufficiency
E Small bowel lymphoma
The enzymatic degradation of gluten might become an alternative to the gluten-free diet
Vora H et al. A scaleable manufacturing process for pro-EP-B2, a cysteine protease from barley indicated for celiac sprue. Biotechnol Bioeng. 2007 Mar 26; [Epub ahead of print]