ICCE Consensus for Celiac Disease

Introduction

Celiac disease is a disorder in which the ingestion of cereals results in small-intestinal mucosal damage in genetically susceptible individuals. The mucosal lesion develops gradually from inflammation, to crypt hyperplasia and partial or subtotal villous atrophy. The prevalence of celiac disease is now estimated at almost 1 % of the general population in Europe and the United States.

Abdominal symptoms, diarrhea, growth failure, and malabsorption of various nutrients are the most common clinical manifestations of the disease [1]. However, the symptoms are often vague or subclinical, or the patients may be totally asymptomatic. The disease can also appear outside the gut, dermatitis herpetiformis being the most well-known extraintestinal manifestation; the patients suffer from itching papulovesicular skin disease. The mucosal lesion, present in 80 % of patients, is milder than in classic celiac disease. Ataxia, polyneuropathy, and osteoporosis are other disorders appearing outside the intestine in celiac disease. Patients with various autoimmune diseases, such as autoimmune thyroiditis or type 1 diabetes, carry an increased risk of celiac disease [2].

Recent advances, driven by serological assays, have led to the realization that clinically overt typical malabsorption syndrome (chronic diarrhea, weight loss, abdominal distension) represents only a small proportion of patients with celiac disease. Underdiagnosis in the community is due to lack of awareness of the heterogeneity of presentation as well as under use of serological tests, particularly in the primary-care setting. Studies in Europe and the United States suggest that the prevalence of celiac disease may be 1 % of the general population [3] [4], but the clinical prevalence is often 10 times lower.

The diagnosis is made by demonstration of duodenal villous atrophy on specimens usually obtained by esophagogastroduodenoscopy (EGD). It is now possible to assess the small-intestinal villous structure by video capsule endoscopy. This method is well tolerated and offers, at least theoretically, an alternative to EGD. The current position and future prospects of video capsule endoscopy are discussed in this article.

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