CELIAC-DISEASE - DIAGNOSTIC AND THERAPEUTIC PITFALLS

Gluten-free diet (GFD) as the standard treatment for coeliac disease ( CD) was discovered by Dicke. In 1989 Holmes attributed a protective ro le to GFD with regard to the development of malignancy in untreated CD . Gluten sensitivity is in general an asymptomatic condition. The iden tification of subclinical cases is becoming a major topic of current i nterest. Defining high-risk groups for coeliac disease is mandatory. T he evaluation of small-intestine biopsies (SIB), however, is much more complicated, as was suggested in the past. Recognition of the Corazza sign and rediscovery of the endoscopic guided capsule may well be of help. Screening patients with a high-risk of CD with a minimal number of tests prior to SIB makes more and more sense. Therefore intestinal permeability tests might be helpful. GFD appears simple, but in practi ce it represents a challenge to patients, dietitians and physicians. M anagement of coeliac disease seems much more complicated, as was thoug ht in the early 1980s.