Markers of Coeliac Disease Latency

Abstract

Coeliac disease (CD) is a permanent intolerance to dietary cereals. It is the most common malabsorption syndrome in children in Finland, with a prevalence possibly as high as 1:100. In view of the increasing risk of developing malignancies and osteoporosis later in life, it is essential to diagnose CD at an early stage. CD is characterised by a gluten-triggered manifest small-bowel mucosal lesion in genetically susceptible individuals, biopsy specimens showing villous atrophy with crypt hyperplasia and lymphocytic infiltration. The timepoint of the first manifestations of CD has shifted to later ages due to the fact that the clinical presentation of CD has changed during recent years. Classic symptoms such as diarrhoea, loose stools and failure to gain weight have become rare. The symptoms can be atypical, or the patients may even be symptomless. CD can also develop on previously normal mucosa. Patients with such a latent form of CD express a normal jejunal mucosal morphology while on gluten-containing diet, but will later be found to have small-bowel villous atrophy healing on a gluten-free diet. The diagnosis of latent CD can be established only in retrospect. The purpose of present study was to identify markers of CD latency. The present study shows that in patients with normal jejunal mucosal morphology markers are due to be found indicative of development of CD. The study also revealed that CD frequently occurs in patients with primary Sjögren's syndrome. These patients may have asymptomatic gluten sensitve enteropathy which can be detected by serologic screening tests.

Coeliac disease (CD) is a permanent intolerance to dietary cereals. It is the most common malabsorption syndrome in children in Finland, with a prevalence possibly as high as 1:100. In view of the increasing risk of developing malignancies and osteoporosis later in life, it is essential to diagnose CD at an early stage. CD is characterised by a gluten-triggered manifest small-bowel mucosal lesion in genetically susceptible individuals, biopsy specimens showing villous atrophy with crypt hyperplasia and lymphocytic infiltration. The timepoint of the first manifestations of CD has shifted to later ages due to the fact that the clinical presentation of CD has changed during recent years. Classic symptoms such as diarrhoea, loose stools and failure to gain weight have become rare. The symptoms can be atypical, or the patients may even be symptomless. CD can also develop on previously normal mucosa. Patients with such a latent form of CD express a normal jejunal mucosal morphology while on gluten-containing diet, but will later be found to have small-bowel villous atrophy healing on a gluten-free diet. The diagnosis of latent CD can be established only in retrospect. The purpose of present study was to identify markers of CD latency. The present study shows that in patients with normal jejunal mucosal morphology markers are due to be found indicative of development of CD. The study also revealed that CD frequently occurs in patients with primary Sjögren's syndrome. These patients may have asymptomatic gluten sensitve enteropathy which can be detected by serologic screening tests.