ICCE Consensus for Celiac Disease

 

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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.

• 1 Green P H, Jabri B. Coeliac disease.  Lancet. 2003;  362 383-391
  CrossrefPubMedGoogle Scholar
• 2 Collin P, Kaukinen K, Välimäki M, Salmi J. Endocrinological disorders and celiac disease.  Endocr Rev. 2002;  23 464-483
  CrossrefPubMedGoogle Scholar
• 3 Fasano A, Berti I, Gerarduzzi T. et al . Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study.  Arch Intern Med. 2003;  163 286-292
  CrossrefPubMedGoogle Scholar
• 4 Mäki M, Mustalahti K, Kokkonen J. et al . Prevalence of celiac disease among children in Finland.  N Engl J Med. 2003;  348 2517-2524
  CrossrefPubMedGoogle Scholar
• 5 Hill I D, Dirks M H, Liptak G S. et al . Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.  J Pediatr Gastroenterol Nutr. 2005;  40 1-19
  CrossrefPubMedGoogle Scholar
• 6 Working group of the United European Gastroenterology Week in Amsterdam . When is a coeliac a coeliac?.  Eur J Gastroenterol. 2001;  13 1464-1469
  PubMedGoogle Scholar
• 7 Vahedi K, Mascart F, Mary J Y. et al . Reliability of antitransglutaminase antibodies as predictors of gluten-free diet compliance in adult celiac disease.  Am J Gastroenterol. 2003;  98 1079-1087
  CrossrefPubMedGoogle Scholar
• 8 Abdulkarim A S, Burgart L J, See J, Murray J A. Etiology of nonresponsive celiac disease: results of a systematic approach.  Am J Gastroenterol. 2002;  97 2016-2021
  CrossrefPubMedGoogle Scholar
• 9 Green P H, Fleischauer A T, Bhagat G. et al . Risk of malignancy in patients with celiac disease.  Am J Med. 2003;  115 191-195
  CrossrefPubMedGoogle Scholar
• 10 Cellier C, Delabesse E, Helmer C. et al . Refractory sprue, coeliac disease, and enteropathy-associated T-cell lymphoma. French Coeliac Disease Study Group.  Lancet. 2000;  356 203-208
  CrossrefPubMedGoogle Scholar
• 11 Fine K D, Meyer R L, Lee E L. The prevalence and causes of chronic diarrhea in patients with celiac sprue treated with a gluten-free diet.  Gastroenterology. 1997;  112 1830-1838
  PubMedGoogle Scholar
• 12 Cellier C, Patey N, Mauvieux L. et al . Abnormal intestinal intraepithelial lymphocytes in refractory sprue.  Gastroenterology. 1998;  114 471-481
  PubMedGoogle Scholar
• 13 Mention J J, Ben Ahmed M, Begue B. et al . Interleukin 15: a key to disrupted intraepithelial lymphocyte homeostasis and lymphomagenesis in celiac disease.  Gastroenterology. 2003;  125 730-745
  CrossrefPubMedGoogle Scholar
• 14 Petroniene R, Dubcenco E, Baker J P. et al . Given capsule endoscopy in celiac disease: evaluation of diagnostic accuracy and interobserver agreement.  Am J Gastroenterol. 2005;  100 685-694
  CrossrefPubMedGoogle Scholar
• 15 Murray J A, Brogan D, Van Dyke C. et al . Mapping the extent of untreated celiac disease with capsule enteroscopy.  Gastrointestinal Endosc. 2004;  59 AB101
  PubMedGoogle Scholar
• 16 Krauss N, Cellier C, Collin P. et al .Evaluation of capsule endoscopy in celiac patients with ongoing symptoms on a gluten-free diet: first results of a prospective blinded European multicenter trial.  In: Proceedings of the 4th International Conference on Capsule Endoscopy, Miami, Florida, 2005. Yoqneam, Israel; Given Imaging 2005
  Google Scholar
• 17 De Franchis R, Riccioni M E, Cave D. et al .Video capsule endoscopy for the diagnosis of celiac disease: preliminary results from a multicenter international study.  In: Proceedings of the 4th International Conference on Capsule Endoscopy, Miami, Florida, 2005. Yoqneam, Israel; Given Imaging 2005
  Google Scholar
• 18 Shcherbakov P L, Lokhmatov V. Video capsule endoscopy in pediatrics.  In: Proceedings of the 4th International Conference on Capsule Endoscopy, Miami, Florida, 2005. Yoqneam, Israel; Given Imaging 2005
  Google Scholar
• 19 Guilhon de Araujo Sant’Anna A M, Dubois J, Miron M C, Seidman E G. Wireless capsule endoscopy for obscure small bowel disorders: final results of the first pediatric controlled trial.  Clin Gastroenterol Hepatol. 2005;  3 264-270
  CrossrefPubMedGoogle Scholar
• 20 Hill I D, Dirks M H, Liptak G S. et al . Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.  J Pediatr Gastroenterol Nutr. 2005;  40 1-19
  CrossrefPubMedGoogle Scholar
• 21 James S P. National Institutes of Health consensus development conference statement on celiac disease, June 28-30, 2004.  Gastroenterology. 2005;  128 S1-9
  CrossrefPubMedGoogle Scholar
• 22 Culliford A, Daly J, Diamond B, Rubin M, Green P H. The value of wireless capsule endoscopy in patients with complicated celiac disease.  Gastrointest Endosc. 2005;  62 55-61
  CrossrefPubMedGoogle Scholar
• 23 Walker-Smith J A, Guandalini S, Schmitz J. et al . Revised criteria for diagnosis of coeliac disease. Report of Working Group of European Society of Paediatric Gastroenterology and Nutrition.  Arch Dis Child. 1990;  65 909-911
  CrossrefPubMedGoogle Scholar

J. Murray, M. D.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic College of Medicine

200 First Street SW · Rochester · MN 55905 · USA

Email: murray.joseph@mayo.edu