Celiac disease - what shoUld an ambulant internist know

Celiac disease (celiac sprue gluten sensitive entheropathy, nontropic sprue) is the life long hereditary autoimmune disease. It manifests in a geneticaly succeptible individual (association with HLA-DQ2, HLS-DQ8) after a variable time of the consumation of gluten containing cereals. Imunopathogenesis of celaic sprue has not been fully discovered. It is supposed that gliadin peptides (split products of gluten) after presentation to HLA- DQ2 and HLA-DQ8 possitive cells of predisposed individuals trigger in the mucosa of the small bowel an exaggerated reaction (T cell mediated immune response). In the same time highly specific autoimmune antibodies are produced (antibodies against tissue transglutaminase). Final result of reaction to gluten is a damage to small bowel mucosa with variable degree of atrophy and inflammatory changes. Clinical picture of celiac sprue is variable. Typical picture of malabsorption with diarrhea and steatorhea, abdominal distension, anemia, weight loss and slowing of somatic and psychologic development are characteristic mainly for pediatric patients. In adults we observe in patients with celiac sprue frequently minimal gastrointestinal symptomps with dyspepsy or fatigue syndrom. Extraintestinal manifestation prevails with sideropenic anemia and exaggerated osteoporosis. In routine clinical practice a large proportion of patietns with celiac sprue remains undiagnosed and the disease is considered to be uncommon. A necessity for succesful diagnosis of celiac sprue are informed primary care physicians (general practitionars and specialists with an exception of gastroenterologists) who can make use of available methods of targeted screening of early diagnosis of this disease.

Keywords: celiac disease, gluten, serologic screening, diagnosis of celiac sprue, gluten free diet