Diagnostic Tests: Gluten enteropathy

Warwick Selby
2001 Australian Prescriber  
SYNOPSIS The presentation of coeliac disease is changing, and typical malabsorption is now uncommon. Patients are more likely to present with non-specific symptoms or with iron and/or folate deficiency. The diagnosis still depends upon finding villous atrophy in the small intestine by endoscopic biopsy of the distal duodenum. The mucosal changes should improve after the patient has followed a gluten-free diet for at least six months. IgA antibodies to gliadin, endomysium and/or tissue
more » ... or tissue transglutaminase are detectable in most untreated patients. Antibody testing should not be used alone to make the diagnosis, because of the possibility of false positive results. This testing is used in patients where the clinical index of suspicion is low, in those with one of the disorders associated with coeliac disease or for screening relatives. Everyone with detectable antibodies requires a small bowel biopsy. Patients in whom the clinical index of suspicion of the disease is high should undergo biopsy regardless of the results of antibody testing. There is no place for an empirical trial of a gluten-free diet if coeliac disease is suspected.
doi:10.18773/austprescr.2001.036 fatcat:l5f65ogi4rd4neeyehciudvcce