Coeliac Disease

An excellent BMJ leader prompted me to reconsider this condition. Here are some take home messages:

• affects 0.3 to 1% of the population
• 1/4 of patients receive the diagnosis after the age of 60!
• conventional diagnosis rests on villous atrophy in the small bowel which recovers after a gluten free diet
• screening is possible - anti-endomysial and anti-transglutaminase antibodies are often used
• positive antibody tests are not diagnostic - sometimes they become negative again.
• sometimes positive Ab tests are followed by negative biopsies - it's worth reviewing the biopsy. Has the patient stopped gluten before the biopsy?
• Ab negative cases do occur, most commonly in IgA deficiency.

For me the key things are - don't forget to think of it as a possibility, even in the older patient.