Coeliac disease: new tests, new genes and rising prevalence

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• Recent data suggest that coeliac disease is becoming more common, not just because of increased clinical awareness, but also because the incidence is climbing. In the USA, the incidence of young males who are seropositive for both anti-tissue transglutaminase antibodies (tTG IgA) and endomysial antibodies rose almost five-times over 50 years to 0.9% in 2000. A similar rise has been observed in Finland, with a doubling in the prevalence of coeliac disease since 1980 to about 2% of the adult population in 2000. A rising prevalence of coeliac disease has been associated with a generally milder presentation; however, recent reports indicate an increased mortality associated with unrecognised coeliac disease whether it be manifest by subtotal villous atrophy or subtle intraepithelial lymphocytosis on small bowel histology.