Microalbuminuria and nephropathy in insulin dependent diabetes mellitus.

Challacombe 3-2/1000 was high for Italy and other countries in Europe, suggesting that coeliac disease in childhood may be more common than has previously been recognised. However, of 11 subclinical cases of coeliac disease reported after screening, nine had recognisable clinical features of this disorder such as recurrent apthous stomatitis, iron deficiency anaemia, recurrent diarrhoea, or short stature. The study raises important questions about the value of population screening for coeliac disease and whether patients would benefit by being identified at a symptomless stage.18 Children with coeliac disease are considered to have a lifelong intolerance to dietary gluten, yet only a third of adults with this disorder gave a history of coeliac disease in childhood .19 Screening would not only identify children with unrecognised disease but also detect disease in adults, in whom delayed diagnosis or misdiagnosis is common, because a chronic state of ill health is often accepted as normal. Screening families for coeliac disease AGA testing in serum has been successfully used to screen relatives of patients with coeliac disease,20 in whom there is a strong association with class II HIA genes. As most of the affected relatives are symptom free, they would normally be reluctant to undergo intestinal biopsy. Yet malignancy and cancer deaths2l occur more frequently in first degree relatives and a gluten free diet would have a protective effect on them.22 Conclusions Measurement ofAGA, AEA, and ARA antibodies in serum are valuable in screening children for coeliac disease, but jejunal biopsy remains the 'gold standard' for making the diagnosis. The arguments for population screening may increase as these tests become more reliable. The indications for treating asymptomatic patients with coeliac disease with a gluten free diet need to be established. Some adolescents with the disease do not keep to their gluten free diet, yet have no symptoms. Less contentious are the arguments for using a gluten free diet to treat patients with symptomatic coeliac disease; in these cases there is often a remarkable improvement in mood and general wellbeing within a few days of starting treatment.23 1 Meeuwisse GW. Diagnostic criteria in coeliac disease: report of a round table discussion. The use of a stathmokinetic technique with crypt microdissection to estimate the crypt cell production rate in cultured explants of the duodenal mucosa in celiac disease.