Current approaches to diagnosis and treatment of celiac disease: An evolving spectrum

Celiac disease (CD) is a syndrome characterized by damage of the small inte stinal mucosa caused by the gliadin fraction of wheat gluten and similar al cohol-soluble proteins (prolamines) of barley and rye in genetically suscep tible subjects. The presence of gluten in these subjects leads to self-perp etuating mucosal damage, whereas elimination of gluten results in full muco sal recovery. The clinical manifestations of CD are protean in nature and v ary markedly with the age of the patient, the duration and extent of diseas e, and the presence of extraintestinal pathologic conditions. In addition t o the classical gastrointestinal form, a variety of other clinical manifest ations of the disease have been described, including atypical and asymptoma tic forms. Therefore, diagnosis of CD is extremely challenging and relies o n a sensitive and specific algorithm that allows the identification of diff erent manifestations of the disease. Serologic tests developed in the last decade provide a noninvasive tool to screen both individuals at risk for th e disease and the general population, However, the current gold standard fo r the diagnosis of CD remains histologic confirmation of the intestinal dam age in serologically positive individuals. The keystone treatment of CD pat ients is a lifelong elimination diet in which food products containing glut en are avoided.