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Feature Article

Coeliac disease: a practical overview

John Almeida, Christopher S Pokorny

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Abstract

In contrast to the classic malabsorption picture, coeliac disease generally presents nowadays with more subtle symptoms, such as fatigue, anaemia, reduced bone density and nonspecific GI symptoms often wrongly labelled as being due to the irritable bowel syndrome.

Key Points

  • The prevalence of coeliac disease is reportedly as high as one in 100. Both Caucasians and non-Caucasians are affected, but it is extremely rare in Chinese, Japanese and Afro-Caribbean people.
  • In contrast to its classic presentation with malabsorption, there is increasing recognition of more subtle presentations, including fatigue from anaemia secondary to iron and/or folate deficiency, osteoporosis and nonspecific gastrointestinal symptoms.
  • Coeliac disease should be considered in patients with symptoms suggestive of irritable bowel syndrome as well as in those with type 1 diabetes or osteoporosis.
  • Relatives of people with coeliac disease are at an increased risk of the condition and should be screened.
  • Serology is useful for screening, but histology is the gold standard for diagnosis.
  • Assessment for all nutritional consequences, including bone disease, is vital.
  • Lifelong adherence to a gluten-free diet is important to reduce symptoms and prevent complications. Noncompliance is the most common cause for nonresponse.

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