Medical progress: Celiac disease

Celiac disease occurs in nearly 1% of the population in many countries. The diagnosis, which is straightforward in most cases, is usually established on the basis of serologic testing, duodenal biopsy, and observation of the response to a glutenfree diet. A poor response to the diet is common and requires extensive evaluation to rule out intestinal lymphoma and refractory sprue, complications that arise as the result of clonal expansion of intraepithelial lymphocytes. Increasing awareness of the epidemiology and diverse manifestations of the disease, as well as the availability of sensitive and specific serologic tests, especially among primary care physicians, will lead to more widespread screening and diagnosis, which in turn will lead to greater availability of gluten-free foods and efforts to develop drug therapies that relieve patients of the burden of a gluten-free diet. In addition, earlier diagnosis may lead to a reduction in the complications of the disease. Copyright © 2007 Massachusetts Medical Society.