Celiac Disease in Adults

Celiac disease (CD) is a common conditon afectng up to 1% of the adult populaton of Caucasoid origin. It arises from an infammatory response to dietary gluten in the small intestne in genetcally predisposed individuals. Its clinical presentatons are grouped into four categories: 1) Classic celiac disease, defned on the basis of diarrhea with failure to thrive or weight loss (a rare occurrence in contemporary adult presentaton in); 2) “Atypical” gastrointestnal presentaton, defned on the basis of a set of nonspecifc and persistent gastrointestnal symptoms, ofen misdiagnosed as a digestve functonal disorder; 3) Extraintestnal presentaton, defned on the basis of signs or symptoms outside the gastrointestnal tract, such as iron defciency anemia or short stature and 4) Silent presentaton. The later is identfed through testng due to a family history of CD or a celiac disease-associated conditon (i.e. type 1 diabetes mellitus). The CD diagnosis is confrmed if at least 4 of the following 5 criteria are satsfed: typical CD symptoms, serum-positve celiac disease class-A immunoglobulin autoantbodies at high tters, presence of HLA-DQ2 and/or-DQ8, celiac enteropathy in small bowel biopsy and response to the gluten-free diet. Seronegatve CD is likely to be underestmated due to the tendency to perform small intestnal biopsies only in patents with positve celiac disease serum markers. Whilst the majority of patents will respond to a gluten-free diet, a signifcant minority will contnue to be symptomatc. In such cases, it is essental that a systematc follow-up approach be adopted.