Topics Discussed: celiac disease; childhood celiac disease; gastroenterology and hepatology.
Sections: Clinical Presentation, Differential Diagnosis, Diagnosis, Controversies, Treatment, New Therapies under Investigation, Prevention, References.
Excerpt:"Celiac disease (CD) is "a permanent sensitivity to gluten
in wheat and related proteins found in barley and rye, occurring
in genetically susceptible individuals, and manifesting as an immune mediated
enteropathy as defined by characteristic changes seen on intestinal
histology."1 A conservative
definition requires the following:The prevalence in the United States and Europe is roughly 313
cases per 1000 individuals (1:300 to 1:80).1 There is a
female predominance with a ratio of roughly 2:1.2 These
estimates indicate that there are approximately 3 million people
with CD in the United States alone, and a roughly equal number in
Europe, of which 90% are undiagnosed (Table 181). Recent
screening studies suggest that in developing countries in Africa,
parts of Asia, and South America, the frequency is similar to that
of the U.S. and European countries.3 To date, there are
very little data exploring the rates of CD in China, Japan, and
Southeast Asian countries, and these populations are thought to
be at lower genetic risk for CD. A number of conditions are associated
with an increased risk of CD in children and adults (Table 182).
- typical signs or symptoms;
- presence of CD-associated antibodies;
- a small intestinal biopsy showing villous atrophy;
- resolution of clinical manifestations with a gluten-free diet
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