The diagnosis of gluten sensitivity and coeliac disease - the two are not mutually inclusive

The traditional definition of coeliac disease is inadequate because it incl udes only patients with abnormal small intestinal morphology, Gluten sensit ivity is a systemic disorder whose common factor is an immune response to g luten in the context of the susceptible 'coeliac' HLA haplotype and possibl y environmental triggers. Gluten sensitivity embraces traditional coeliac d isease as well as subjects with normal small bower morphology including lat ent coeliac disease, dermatitis herpetiformis, and symptomatic gluten intol erance. The diagnosis of gluten sensitivity and coeliac disease are not mut ually inclusive. Small intestinal biopsy and clinical criteria are essentia l in diagnosing classical coeliac disease. IgA endomysial antibody is valua ble in identifying gluten sensitivity and has particular value as a screeni ng test. Serology should include total IgA levels to exclude selective IgA deficiency, a potential cause of false negative IgA endomysial antibody. A combination of histology, serology and clinical criteria will identify most cases of coeliac disease and gluten sensitivity. Eur J Gastroenterol Hepat ol 10:911-913 (C) 1998 Lippincott Williams & Wilkins.