THE SPECTRUM OF CELIAC-DISEASE IN CHILDREN

Coeliac disease is the life-long intolerance to dietary gluten, usuall y characterized by severe damage to the small-intestinal mucosa. The w idespread use of sensitive diagnostic tools, such as the serum anti-gl iadin and the anti-endomysial antibodies, has shown not only that coel iac disease is one of the commonest disorders in Western countries but also that this condition is characterized by a higher degree of clini cal variability than previously thought (typical, atypical and silent forms). The existence of a latent-potential coeliac disease and even a gluten-sensitive disease with immunological activation of an otherwis e normal small-intestinal mucosa has recently been postulated. An incr eased prevalence of coeliac disease in a number of other disorders has also been reported in both children and adults. The reasons for such a wide clinical heterogeneity are still poorly understood but are like ly to depend on both genetic and environmental factors. Further invest igations are required to evaluate the impact of undiagnosed, clinicall y milder forms of coeliac disease on the well-being of the population.