Recent advances in clinical practice RECENT ADVANCES IN COELIAC DISEASE

Correspondence to: Professor D A van Heel, Institute of Cell and Molecular Science, Barts and The London, Queen Mary’s School of Medicine and Dentistry, Turner St, London E1 2AD, UK; [email protected] _________________________ T he management of coeliac disease is an increasing part of a gastroenterologist’s workload. Recent prevalence studies suggest ,1% of the general UK population have positive coeliac serology, which combined with increasing population and primary care awareness is leading to more and more referrals. The majority of contemporary referrals are now initially diagnosed by highly sensitive and specific serological tests followed by readily performed endoscopic biopsy (fig 1). Consequently, we now identify many more patients with no or only mild clinical symptoms, making the classical scenario of diarrhoea/steatorrhoea and weight loss a comparative rarity. Much of the early data on clinical aspects of classical coeliac disease (that is, published pre ,1990) may not be applicable to contemporary coeliac disease. These changes in clinical practice have been paralleled by a dramatic increase in our knowledge of disease pathogenesis, making coeliac disease the best understood human ‘‘autoimmune’’ disorder. In this review article, we present selected major recent advances in both clinical and basic science aspects of coeliac disease, focusing on the many high quality studies published within the last five years.