Coeliac disease varies in its clinical expression, and so
currently is defined on the basis of small-bowel mucosal pathology - a
permanent gluten-sensitive enteropathy. Elimination of gluten-containing
foods from the diet is the mainstay of long-term treatment. Patients
with active coeliac disease have nutritional deficiencies and/or
diarrhoea but a full malabsorption syndrome is relatively rare. Dietary
treatment should be offered to all patients with active disease.
Clinically silent coeliac disease is now being increasingly recognized for example in people in whom jejunal biopsy has been performed as part of a research study. There is, as yet, no agreement among gastroenterologists on whether or not a gluten-free diet should be recommended for silent coeliac disease (the aim being to prevent the development of symptomatic disease, significant nutrient deficiencies or complications). Some might argue that a disease is always symptomatic - in which case the term preferred by many patients, 'coeliac condition' might be more appropriate. However, there is abundant evidence of nutritional and immunological abnormalities in many apparently symptomless people with coeliac disease. Research is currently in progress to establish whether such patients are affected by subclinical but important health problems, such as infertility or osteoporosis. They will, like other such patients who are untreated, certainly have an increased (although still fairly low) risk of enteropathy-associated T-cell lymphoma, and of small-bowel adenocarcinoma.
Aetiology
Genetic and environmental factors alike are involved. Coeliac disease has a strong association with a particular human leucocyte antigen (HLA) type; about one in ten of first-degree relatives will also be affected. The disease will only be expressed if the genetically predisposed individual eats gluten from wheat and other cereals. Factors such as breast-feeding practice, age at weaning and prevalence of gastrointestinal infections may also be relevant to the differences in age and type of clinical presentation in different countries. The diseaseprovoking component of cereals, gluten, is a protein and raw and cooked foods such as breads, biscuits, cakes and pasta are harmful to patients. A diet without gluten is nutritionally entirely adequate - indeed, for almost half of the human race, the staple diet is gluten-free.
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Clinically silent coeliac disease is now being increasingly recognized for example in people in whom jejunal biopsy has been performed as part of a research study. There is, as yet, no agreement among gastroenterologists on whether or not a gluten-free diet should be recommended for silent coeliac disease (the aim being to prevent the development of symptomatic disease, significant nutrient deficiencies or complications). Some might argue that a disease is always symptomatic - in which case the term preferred by many patients, 'coeliac condition' might be more appropriate. However, there is abundant evidence of nutritional and immunological abnormalities in many apparently symptomless people with coeliac disease. Research is currently in progress to establish whether such patients are affected by subclinical but important health problems, such as infertility or osteoporosis. They will, like other such patients who are untreated, certainly have an increased (although still fairly low) risk of enteropathy-associated T-cell lymphoma, and of small-bowel adenocarcinoma.
Aetiology
Genetic and environmental factors alike are involved. Coeliac disease has a strong association with a particular human leucocyte antigen (HLA) type; about one in ten of first-degree relatives will also be affected. The disease will only be expressed if the genetically predisposed individual eats gluten from wheat and other cereals. Factors such as breast-feeding practice, age at weaning and prevalence of gastrointestinal infections may also be relevant to the differences in age and type of clinical presentation in different countries. The diseaseprovoking component of cereals, gluten, is a protein and raw and cooked foods such as breads, biscuits, cakes and pasta are harmful to patients. A diet without gluten is nutritionally entirely adequate - indeed, for almost half of the human race, the staple diet is gluten-free.
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