Diagnosis of coeliac disease

Follow up and review are needed when test results are not clear

Two articles in this issue remind us about coeliac disease and the need to consider it as a diagnosis in seemingly unusual circumstances—in elderly patients and in obese patients (p 773, 775).1 2 Furthermore, in the patient reported by Saunders et al, the usual diagnostic features of anti-endomysial and anti-transglutaminase antibodies and histological enteropathy were absent initially.1

Coeliac disease is a relatively common condition. Its prevalence is approximately 0.3-1% of the population in almost all countries and ethnic groups where it has been investigated.3 Previously regarded largely as a childhood problem it is now recognised to affect mostly adults, with about 25% of patients receiving their diagnosis at over 60 years of age.4 When present, the features of malabsorption (diarrhoea and weight loss) should point to the diagnosis, but now a wide range of clinical manifestations are recognised. Patients often have few or no gastrointestinal symptoms and can even be obese.2 5

Conventionally diagnosis is based on the histological finding of …