Dictionary of Allergies .. Celiac disease

Celiac disease

Celiac disease is a relatively common gastrointestinal disorder secondary to a hypersensitivity response to gluten-containing grains. The mechanisms responsible for this disorder are unknown, but a recent analysis of the spectrum of immunopathologic changes in the small bowel support the notion that gluten-sensitivity is cell-mediated in type, and the degree of mucosal change is probably the result of host genetic factors. See Gluten; gliadin; cereal grains[1]. Clinical, serological and histological remission in celiac disease is strictly related to long life complete exclusion of gluten from the diet. Because celiac disease is an autoimmune systemic disorder the potential complications include a wide spectrum with two severe long-term morbidities: osteoporosis and malignancy.

Gluten free diet, easy to be recommended, is difficult to be followed [4]. Selection of patients for diagnostic biopsy concerning celiac disease (CD) is mainly guided by the results with serological screening tests like anti-tissue-transglutaminase (tTG), anti-endomysium (EmA) and anti-gliadin (AGA) IgA. New tests using deamidated gliadin-derived peptides (DGP) including both IgA and IgG antibodies have been developed, to cover the IgA-deficient sera. In addition, a combined IgA and IgG DGP test, with or without human erythrocyte-derived tTG, offers possible advantages [2]. The patchy nature of villous lesion in celiac disease is increasingly being recognized. Current guidelines recommend four endoscopic duodenal mucosal biopsies from the second or more distal part of the duodenum to confirm the diagnosis of celiac disease [3].

The lesion in celiac disease in children can be patchy with duodenal bulb mucosa being the only area showing histological changes. The recommendations regarding the site of biopsies should be revised to include biopsies not only from distal duodenum but also from bulb to improve the diagnostic yield[3]. Selection of patients for diagnostic biopsy concerning celiac disease (CD) is mainly guided by the results with serological screening tests like anti-tissue-transglutaminase (tTG), anti-endomysium (EmA) and anti-gliadin (AGA) IgA. New tests using deamidated gliadin-derived peptides (DGP) including both IgA and IgG antibodies have been developed, to cover the IgA-deficient sera. In addition, a combined IgA and IgG DGP test, with or without human erythrocyte-derived tTG, offers possible advantages. In order to explore the screening accuracy of the new combination tests sera from 167 children below 3 years of age were assayed[5].

References

1. Marsh, M.N.: Immunol. Invest. 1989:18:509-531.Walker - Smith, J.A., et al: Report of working group of European Society of Paediatric Gastroenterology and Nutrition (ESPGAN) Revised criteria for diagnosis of celiac disease. Arch. Dis. Child. 1990:65:909-911.

2. Aberg AK, Olcén P. Serologic screening for celiac disease in children: a comparison between established assays and tests with deamidated gliadin-derived peptides plus conjugates for both IgA and IgG antibodies. APMIS. 2009 Nov;117(11):808-133.

3. Rashid M, Macdonald A. Importance of duodenal bulb biopsies in children for diagnosis of celiac disease in clinical practice. BMC Gastroenterol. 2009 Oct 16;9(1):78.

4. Anca I, Stănescu-Popp A, Arama V, Duţă D, Alexe G, Colcer F. Celiac disease: diagnostic criteria and impact of gluten free diet--patients' perspective. Rev Med Chir Soc Med Nat Iasi. 2008 Apr-Jun;112(2):351-5.

5. Aberg AK, Olcén P. Serologic screening for celiac disease in children: a comparison between established assays and tests with deamidated gliadin-derived peptides plus conjugates for both IgA and IgG antibodies. APMIS. 2009 Nov;117(11):808-13.