New Aspects of the Diagnosis of Celiac Disease in Children, Adolescents, and Adults

Abstract

of n spital, pital, .); and e, ology epartayo T he perception of celiac disease (CD) has changed in the past decade from a rare intestinal disease primarily recognized in childhood to a common, genetically determined disease with autoimmune components that affects people of all ages and involves several organs. Part of this change has been based on improved diagnostic measures and screening possibilities in the general population and particularly in at-risk populations, such as family members, patients with type 1 diabetes mellitus, and those with autoimmune thyroid disease. Several suggestions for new definitions of CD have recently been published; complete consensus has as yet not been obtained, but a framework is apparent (Table 1). All the published definitions agree on the presence of overt CD; silent CD, which is CD without recognized symptoms; and potential CD, which is the presence of CD antibodies and a normal duodenal biopsy result. The diagnostic criteria for CD have changed in practice because of these concepts and technological developments. The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) recently developed and launched new ESPGHAN guidelines for the diagnosis of CD. These guidelines not only represent a sea change in thinking about how to reach the diagnosis of CD but also propose, for the first time, basing the diagnosis of an immune disorder largely, if not completely, on serologic tests. This comes at a time when the detection and largely the management of CD increasingly involve general practice. At the same time, the diagnostic algorithms are becoming complicated, necessitating specialized knowledge apart from procedures and biopsies. The diagnosis and indeed definition of CD have for decades been based on histologic damage to the small intestine. Previous diagnostic criteria promulgated by ESPGHAN and other organizations, such as the American Gastroenterology Association and a consensus group convened in Europe, pertinent to adults all