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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Editorial Board Member: Gillery, Philippe / Kazmierczak, Steven / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Schlattmann, Peter / Whitfield, John B.

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Coeliac disease – a diagnostic and therapeutic challenge

Katri Kaukinen1, 2 / Katri Lindfors2 / Pekka Collin1, 2 / Outi Koskinen2 / Markku Mäki3

1Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland

2Medical School, University of Tampere, Tampere, Finland

3Paediatric Research Centre, University of Tampere and Tampere University Hospital, Tampere, Finland

Corresponding author: Dr. Katri Kaukinen, MD, PhD, Medical School, Finn-Medi 3, 33014 University of Tampere, Finland Phone: +358 3 3551 8403, Fax: +358 3 3551 8402,

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 48, Issue 9, Pages 1205–1216, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: 10.1515/CCLM.2010.241, June 2010

Publication History

Received:
2010-02-12
Accepted:
2010-03-14
Published Online:
2010-06-28

Abstract

During the past 20 years the diagnosis of coeliac disease has improved significantly. However, at the same time the true prevalence of the condition has doubled, involving more than 2% of the population in some countries. Due to mild or atypical symptoms, the diagnosis remains a challenge for the health care system. Highly sensitive and specific serum endomysial and transglutaminase-2 antibody tests are helpful in identifying patients for diagnostic endoscopy and small-bowel biopsy. The diagnosis of the disease is still based on the demonstration of gluten-induced small-bowel mucosal villous atrophy with crypt hyperplasia. However, coeliac disease may manifest itself before the development of the overt small-intestinal lesion. Positive endomysial and transglutaminase antibodies in patients with normal small-bowel mucosal villous architecture may indicate early stage coeliac disease. Currently, the only effective treatment for the condition is a life-long strict gluten-free diet. Long-term regular follow-up of patients is recommended in order to maintain good adherence to the diet.

Clin Chem Lab Med 2010;48:1205–16.

Keywords: coeliac disease; dermatitis herpetiformis; gluten-free diet; malignancy; oats; transglutaminase-2; villous atrophy

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